Community-based Mobile Cervical Cancer Screening Program in Rural India: Successes and Challenges for Implementation

Document Type : Research Articles

Authors

1 Public Health Research Institute of India, Mysore, India.

2 School of Medicine, University of California Irvine, Irvine, USA.

3 Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, USA.

4 Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA.

5 Department of Biochemistry, JSS Medical College, Leader, Special Interest Group (SIG) in Cancer Biology and Cancer Stem Cells JSS Academy of Higher Education & Research, Mysore, Karnataka, India.

6 Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, USA.

7 Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, USA.

Abstract

Background: The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India. Methods: Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial “screen and treat” protocol was transitioned to “screen, test, and treat” using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations. Results: Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under “screen and treat”, 56/156 (35.9%) women accepted same-day treatment. Under “screen, test, and treat”, 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies. Conclusions: Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.

Keywords

Main Subjects


Volume 22, Issue 5
May 2021
Pages 1393-1400
  • Receive Date: 03 September 2020
  • Revise Date: 21 April 2021
  • Accept Date: 23 May 2021
  • First Publish Date: 23 May 2021