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

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: Cervical cancer; Community Outreach; Mobile Clinic; cancer screening.

Figure 1

Results of a Community-Based Mobile Cervical Cancer Screening Program Using a “Screen and Treat” Visualization with Acetic Acid Protocol in Mysore, India, 2010-2018. a, Visual inspection with acetic acid; b, Adequate refers to the visualization of entire SCJ. Inadequate refer to incomplete visualization of SCJ; c,VIA positive indicates the presence of an opaque, dense, distinct acetowhite lesion with sharp margins on the cervix in close proximity to SCJ. VIA negative indicates the absence of such a lesion; Note, Some women received Pap smears and biopsies in addition to LEEP and cryosurgery

Figure 2

Results of a community-based mobile cervical cancer screening program using a “screen, test, and treat” visualization with acetic acid protocol in Mysore, India, 2010-2018. a, Visual inspection with acetic acid; b, Adequate refers to the visualization of entire SCJ. Inadequate refer to incomplete visualization of SCJ; c, VIA positive indicates the presence of an opaque, dense, distinct acetowhite lesion with sharp margins on the cervix in close proximity to SCJ. VIA negative indicates the absence of such a lesion