TY - JOUR
T1 - Community-based Mobile Cervical Cancer Screening Program in Rural India
T2 - Successes and Challenges for Implementation
AU - Srinivas, Vijaya
AU - de Cortina, Sasha Herbst
AU - Nishimura, Holly
AU - Krupp, Karl
AU - Jayakrishna, Poornima
AU - Ravi, Kavitha
AU - Khan, Anisa
AU - Madhunapantula, Subba Rao V.
AU - Madhivanan, Purnima
N1 - Funding Information:
Our thanks to Rhoda Nussbaum and John Adams from PINCC who provided initial support and training. Our thanks to all sponsoring organizations, the District Health Officer, Taluk Health Officers, ASHAs, ANMSs, Anganwadi workers, and all other leaders and groups who facilitated our work in the community. Our thanks to the administrators of St. Joseph Hospital, Cheluvamba Hospital, and JSS Hospital and Department of Pathology, especially Dr. Nandini N.M. Special thanks to Anne K. Erickson, Shirali Pandya, Jasper Werby, Fazila Begum, Savitha Gowda, Rani Chinnappa, Chandramani Meena, Rashmi Pramathesh, and the entire PHRII team for their support. Finally, we sincerely thank all the women and men of Mysore who participated in this program.
Publisher Copyright:
© 2021. All Rights Reserved.
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Cancer screening- cervical cancer- community outreach- mobile clinic
UR - http://www.scopus.com/inward/record.url?scp=85107244247&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85107244247&partnerID=8YFLogxK
U2 - 10.31557/APJCP.2021.22.5.1393
DO - 10.31557/APJCP.2021.22.5.1393
M3 - Article
C2 - 34048166
AN - SCOPUS:85107244247
SN - 1513-7368
VL - 22
SP - 1393
EP - 1400
JO - Asian Pacific Journal of Cancer Prevention
JF - Asian Pacific Journal of Cancer Prevention
IS - 5
ER -