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HPV detection-based cervical cancer screening program in low-resource setting: lessons learnt from a community-based
Srabani Mittal1, Ranajit Mandal1, Dipanwita Banerjee1
1Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
Cancer Causes & Control : CCC
|December 30, 2015
Summary
Implementing human papillomavirus (HPV) detection for cervical cancer screening in Indian primary care is feasible. This approach, utilizing community health workers, shows promise for improving early detection and treatment compliance.
Area of Science:
- Public Health
- Oncology
- Infectious Diseases
Background:
- Cervical cancer remains a significant health burden, particularly in low-resource settings.
- Early detection through effective screening is crucial for reducing mortality.
- Human Papillomavirus (HPV) DNA testing has emerged as a highly sensitive method for cervical cancer screening.
Purpose of the Study:
- To assess the feasibility of implementing HPV detection-based cervical cancer screening in primary care settings in India.
- To generate local evidence on the effectiveness of HPV testing in primary screening.
- To evaluate the role of primary healthcare infrastructure and community health workers in HPV screening programs.
Main Methods:
- A demonstration project screened 44,110 women using the Hybrid Capture 2 HPV DNA test in primary health centers.
- Colposcopy services were provided at community clinics for HPV-positive women.
- Community health workers facilitated community mobilization and patient recall for screening and follow-up.
- Women diagnosed with CIN3+ received treatment at a tertiary hospital.
Main Results:
- HPV positivity rate was 4.7% among screened women.
- Compliance for colposcopy among HPV-positive women was 78%, and for treatment was 80.1%.
- The HPV test detected CIN3+ at a rate of 3.9 per 1,000 women.
- One-year follow-up compliance for HPV-positive women was low (23.2%).
- Concurrent use of Visual Inspection with Acetic acid (VIA) did not improve outcomes and increased unnecessary procedures.
Conclusions:
- HPV detection-based cervical cancer screening is feasible within existing primary healthcare infrastructure in India.
- Performing colposcopy at the primary care level is achievable, enhancing compliance and reducing overtreatment.
- Direct referral of HPV-positive women is recommended in areas with low to moderate HPV prevalence.
- Community health workers are effective in recalling women for follow-up and treatment.
