Background and Context:
WHO recommended HPV test as test-of-choice for primary screening. In low-resource settings, perceived challenges in implementing HPV-detection based screening besides cost issues, are: community mobilization, technically demanding test; logistics of sample transfer maintaining cold-chain; delivery of test reports and recall of positive women.
An implementation research was initiated at Chittaranjan National Cancer Institute (CNCI) to address aforementioned challenges and generate local evidence on feasibility and effectiveness of HPV detection in primary screening
Study was implemented in three rural districts to screen 30-60 year old women. Community mobilization was done by trained multi-purpose workers (MPWs) engaged in other reproductive-health programs. Where MPWs were not available, volunteers from local non-governmental organizations (NGOs) were engaged for community mobilization. Screening clinics were organized in local health-centers. Trained health-workers obtained cervical samples for HPV test. Samples were transferred in vaccine-carriers to CNCI laboratory for HPV detection using Hybrid Capture 2 (HC2) technology. Test results were distributed through MPWs or NGO volunteers who also recalled the positive women for colposcopy and biopsy at rural clinics. Biopsy-proved CIN2/CIN3 were treated either by cryotherapy at rural clinics or by LEEP at CNCI.
Among 36285 women screened, test-positivity was 4.8% and detection-rate for CIN2+ was 0.7%. Positive predictive value of HC2 was 11.1%. Compliance to immediate recall was higher when done by MPWs compared to NGO volunteers (73.8% vs 68.5%). Overall compliance to treatment was 85.4% (228/267) with no difference in compliance rates between women recalled by MPWs and by NGO volunteers. However, follow-up of treated women after one year was poor (23.7%).
Outcomes/What was learned:
HPV detection based screening is feasible in low-resource setup. Samples can be collected from multiple facilities and transported to a central laboratory for analysis. MPWs can be efficiently utilized for community mobilization and recall of positive women.