Meta-analysis of NHPI populations shows low pooled Pap testing and HPV vaccine initiation rates with high treatment disparities.

BACKGROUND: Native Hawaiian and Pacific Islander (NHPI) populations face significant disparities in cervical cancer prevention and treatment. This systematic review and meta-analysis examines cervical cancer prevention metrics, treatment disparities, and effective interventions among NHPI populations. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Scopus, and Embase for studies published between 2000 and 2024 that reported cervical cancer prevention metrics in NHPI populations. Eligible studies included quantitative and qualitative designs with NHPI-specific or disaggregated data. Pap testing and HPV vaccination rates were pooled using a random-effects meta-analysis. Narrative synthesis summarized findings from studies unsuitable for meta-analysis. RESULTS: A total of 27 studies were included. The pooled Pap testing rate was 62% (95% CI: 46%-75%), with substantial heterogeneity (I² = 98.7%). The pooled HPV vaccine initiation rate was 25% (95% CI: 16%-37%; I² = 84.3%). Barriers included limited healthcare access, lack of physician recommendations, cultural stigma, and geographic isolation. Effective interventions, such as culturally tailored educational materials and community-based participatory approaches, demonstrated improved screening and vaccination rates. NHPI patients were less likely to receive timely and guideline-concordant cervical cancer treatment and had higher rates of late-stage diagnoses and mortality. CONCLUSIONS: NHPI populations face persistent cervical cancer prevention and treatment disparities. Culturally tailored interventions and policies addressing systemic barriers are critical to reducing these inequities. Future research should focus on longitudinal studies and scalable interventions to improve outcomes in NHPI communities.