A community‐based, cross‐sectional study of hrHPV DNA self‐sampling‐based cervical cancer screening in rural Karnataka, India

Abstract

Objective To examine the feasibility of implementing a high‐risk HPV (hrHPV) DNA‐based screening program for cervical cancer and the prevalence of hrHPV DNA‐positive women in a community setting in rural India. Methods A cross‐sectional study was conducted at the community level in the Hunsur taluk of the Mysore district from January to August 2016. Cervical cancer screening was conducted with self‐collected vaginal samples that were analyzed using the Hybrid Capture 2 (HC2) assay (Qiagen, USA). Results The majority of participants were aged 30–39 years, with no formal schooling, from a lower caste, and lived below an annual household income of US$1499. After group health education and one‐on‐one counseling, a total of 473 women underwent self‐sampling. Of these, 36 (7.6%) were positive for hrHPV and only 24 (66.6%) underwent follow‐up diagnostic triaging. Cancer was detected in two women, who were referred to appropriate healthcare facilities for further treatment. Conclusion Implementation of hrHPV DNA‐based screening tests using self‐sampling can be feasible in rural settings in India. However, substantial resources are required for providing health education and one‐on‐one counseling to inform asymptomatic women about the benefits of testing and, more importantly, to improve compliance with follow‐up.

Diagnostic accuracy of self‐collected vaginal samples for HPV DNA detection in women from South India

“…Community‐based studies from South India observed that self‐sampling is feasible in rural India . Multicentric community‐based studies are needed to evaluate the utility of self‐collected vaginal samples for cervical cancer screening.…”

“…Community-based studies from South India observed that selfsampling is feasible in rural India. 14,25 Multicentric community-based studies are needed to evaluate the utility of self-collected vaginal samples for cervical cancer screening. The mindset of the Indian woman is not to expose herself unless it is an absolute necessity, and this barrier is almost never broken by imparting knowledge.…”

Acceptability and Concordance of Self- Versus Clinician- Sampling for HPV Testing among Rural South Indian Women

“…While there have been reports of their successful use in Africa, Latin America and in developed countries, there is limited data of their use in India (Lazcano-Ponce et al, 2011;Rees et al, 2018). This is also one of the few studies that examined the usefulness of self-sampled swabs for cervical cancer screening in rural India (A Peedicayil et al, 2016;Adsul et al, 2019). Furthermore, the laboratory assessments of both modes of sample collection revealed high concordance when comparing specimens collected by self-sampling and clinician-collected swabs.…”

Building Capacity for Global Cancer Research: Existing Opportunities and Future Directions

“…Cervical cancer research has resulted in innovative methods to address these barriers. Training community health workers to perform visual inspection of the cervix, educating and motivating women particularly in rural areas to self-collect cervical swabs, and instituting more sensitive detection test such as HPV DNA testing are examples of low-cost approaches to facilitate cancer early detection [36][37][38]. Inherent in these approaches are efforts to pair innovations with implementation science and health system strengthening so the most impactful cancer control interventions can be delivered at scale to diverse populations.…”

“…This discipline is characterized by a variety of research designs and methodological approaches, partnerships with key stakeholder groups (e.g., patients, providers, organizations, systems, and/or communities), and the development and testing of ways to effectively and efficiently integrate evidence-based practices, interventions, and policies into routine health settings. Examples of cancer implementation research in global settings include developing protocols to improve adherence to treatment guidelines for tobacco cessation in Vietnam [ 58 ], developing community-based strategies to provide cancer screening hard-to-reach communities in Argentina [ 38 ], and evaluating adoption and acceptability of novel cervical sample collection methods for screening in India [ 37 ]. Considering the variation in health care systems and availability of health delivery personnel, implementation science in LMICs also offers the opportunity to understand innovative quality improvement models and models of integration cancer services into existing disease control programs.…”