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.
Highlights
Cervical cancer is the fourth most common cancer in women globally, with an estimated 569,847 new cases in 2018, and over 90% of cervical cancer deaths occurred in low- and middle-income countries (Arbyn et al, 2020)
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
Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model
Summary
Cervical cancer is the fourth most common cancer in women globally, with an estimated 569,847 new cases in 2018, and over 90% of cervical cancer deaths occurred in low- and middle-income countries (Arbyn et al, 2020). This disparity can be tied to inequalities in education, awareness, and access to screening and treatment for cervical cancer (Devarapalli et al, 2018). 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. Appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored
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