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.
Aim:
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
Strategy/Tactics:
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.
Programme/Policy Process:
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.