title: HPV detection-based cervical cancer screening program in low-resource setting: lessons learnt from a community-based demonstration project in India.
abstract: OBJECTIVE
  A demonstration project was conducted to assess feasibility of implementing HPV detection-based cervical cancer screening in primary care settings in India and to generate local evidence on feasibility and effectiveness of HPV detection in primary screening.
  
  
  METHODS
  The project was implemented by setting up screening clinics at primary health centers. Eligible women were screened by HPV DNA test (Hybrid capture 2). All samples were processed and tested in a single laboratory. Colposcopy services were provided to screen-positive women at the same community clinics. Project utilized services of community health workers for community mobilization, recall of screen-positive and disease-positive women. Women with ≥CIN2 diagnosis were treated at tertiary hospital.
  
  
  RESULTS
  Totally, 44,110 women were screened and HPV positivity was 4.7 %. Compliance to recall of HC2-positive women for colposcopy was 78 %. Detection rate of CIN3+ by HPV test was 3.9/1,000 women. Compliance of women to treatment was 80.1 %. However, compliance of HPV-positive women for follow-up at 1 year was poor (23.2 %). Concurrent use of VIA to screen the women did not have any advantage but increased number of unnecessary colposcopies and biopsies.
  
  
  CONCLUSIONS
  Our project demonstrated that it was possible to implement HPV detection-based screening using existing primary healthcare infrastructure. Performing colposcopy at primary setting is feasible, improves compliance and reduces over-treatment. In settings with low to moderately high HPV prevalence, direct referral of HPV-positive women is advisable. Community health workers can be effectively used for recalling the positive women.
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mandal
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Dipanwita
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Pradip
authors.initials: P
authors.lastname: Das
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Ishita
authors.initials: I
authors.lastname: Ghosh
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Panda
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata, 700026, India. BasuP@iarc.fr.|Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (WHO), 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France. BasuP@iarc.fr.
authors.forename: Partha
authors.identifier: http://orcid.org/0000-0003-0124-4050
authors.initials: P
authors.lastname: Basu
mesh_terms: D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007194:India; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
keywords: Cervical cancer screening; Cervical intraepithelial neoplasia; Colposcopy services; Community mobilization; Demonstration project; Human papillomavirus detection; Hybrid capture 2