Translating Evidence into Practice in Low Resource Settings: Cervical Cancer Screening Tests are Only Part of the Solution in Rural India

Abstract

Background: The majority of women in rural India have poor or no access to cervical cancer screening services, although one-quarter of all cervical cancers in the world occur there. Several large trials have proven the efficacy of low-tech cervical cancer screening methods in the Indian context but none have documented the necessary components and processes of implementing this evidence in a low-resource setting. Methods: This paper discusses a feasible model of implementation of cervical cancer screening programme in low-resource settings developed through a pilot research project carried out in rural Tamilnadu, India. The programme used visual inspection of cervix after acetic acid application (VIA) as a screening tool, nurses in the primary care centres as the primary screeners and peer educators within Self-Help Women groups to raise community awareness. Results: The uptake of screening was initially low despite the access to a screening programme. However, the programme witnessed an incremental increase in the number of women accessing screening with increasing community awareness. Conclusions: The investigators recommend 4 key components to programme implementation in low-resource setting: 1) Evidence-based, cost-effective test and treatment available within the reach of the community; 2) Appropriate referral pathways; 3) Skilled health workers and necessary equipment; and 4) Optimisation of health literacy, beliefs, attitudes of the community.

Cervical Screening Using Visual Inspection with Acetic Acid (VIA) and Treatment with Cryotherapy in Fiji

“…Possible explanations could be the lack of study nurses of Indian descent and different attitudes in younger versus older cohorts of women in the major ethnic groups. Development of targeted systematic local recruitment, community awareness, and understanding of cultural requirements are crucial in the success of screening programs in low resource settings (Isaac et al, 2012;Demirtas, 2013).…”

Challenges of health promotion and education strategies to prevent cervical cancer in India: A systematic review

“…Overall, 77 papers and one dissertation were eligible for analysis and were listed in the order of publication years. [171819202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364656667686970717273747576777879808182838485868788899091929394] The review process is explained in Figure 1.…”

“…The studies consist of different populations such as women and men from different community groups[17202425313235394143454751616669717379808586909293]And attended clinics[2729425259676872757682]Students (nursing/medical/paramedical/nonmedical)[3840464850565860646974818389]Health-care providers (doctors, nurses, and other health workers);[1828365354555657626365667778889194] migrated Indians;[1921262730333437498487] and cervical cancer patients. [23]…”

Rural community’s perspectives on cervical cancer screening: Report of a consensus-planning workshop

“…For any screening programme to be successful, the prerequisite is to have a screening test which is cost-effective and acceptable to the community. In a screening programme, it is known that an effective screening test is only part of the solution [2] . Alliance for Cervical Cancer Prevention (ACCP), an international nonprofit organisation, recommend the role of community's involvement in order to get the maximum output in terms of women's voluntary participation in cervical screening [3] .…”