Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review

Abstract

The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol’s Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6 – 82.6% and specificity ranged from 82.1 – 96.8%. Women between age groups of 30–59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.

Barriers to Cervical Cancer Screening and the Cervical Cancer Care Continuum in Rural Guatemala: A Mixed-Method Analysis

“…However, compared with the interest in screening technologies, there has been less effort to understand the cervical cancer continuum of care and the barriers to screening and follow-up. 16 - 20 This is a gap in knowledge, because multiple factors along the continuum of care affect the effectiveness of screening programs, regardless of the underlying technology. 21 …”

Elimination of cervical cancer: challenges for developing countries

“…Screening with VIA is still the most cost-effective and efficient method of cervical cancer screening in resource-poor countries, however, because it is highly subjective and dependent on training and continued supervision, sensitivity in detecting grade 2 or higher lesions has been reported anywhere from 7.7% to 82.6% compared to care HPV, a low-cost same day testing that has sensitivities above 70%. Screening for HPV offers a more objective approach, and an opportunity to increase screening coverage through self-collection [32,33].…”

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

“…A secondary aim is to demonstrate the feasibility and highlight the operational logistics of conducting community‐based screening of eligible women and follow‐up of screened women—vital information that is often missing from surveillance studies . The team conducting the screening clinics were trained in overseeing and managing community‐based work and were composed of several members, each with a distinct role.…”

“…Country level estimates, however, suggest that the coverage of cervical cancer screening in developing countries is on average 19% compared with 63% in developed countries . Studies from India have identified barriers on several socioecological levels such as lack of knowledge, personal disbelief in prevention of cancer, lack of care‐seeking when asymptomatic, lack of money for treatment, and reduced access to healthcare services . There is evidence that women in low‐resource settings find pelvic exams to be embarrassing, painful, and uncomfortable; therefore, they prefer the self‐sampling option …”