Feasibility of door-to-door HPV DNA screening using self-collected vaginal swabs for early detection of cervical cancer in rural India.

Abstract

e17526 Background: Cervical cancer is the second most common cancer among women in India, with rural women disproportionately affected due to limited awareness and healthcare access. The current mainstay of screening in India is visual inspection of the cervix using acetic acid by a healthcare provider in a hospital setting. This study proposes to evaluate the feasibility and acceptability of a door-to-door cervical cancer screening approach using self-collected vaginal swabs for HPV DNA testing, facilitated by trained non-physician health workers (NPHWs) in a rural community. Methods: This ongoing study is based in Medchal, a rural area in south India, with a cohort of 50,000 individuals registered in a geo-coded database. The project commenced on January6,2025 and we intend to screen 2000 women aged between 25 to 65 years over a period of 6 months, culminating by June, 2025. NPHWs, trained by a gynaecologist, educate women aged 25-65 (non-pregnant, non-menstruating, with an intact uterus) on cervical cancer, the importance of screening, and the self-sampling procedure. The NPHWs possess masters in social work degree. NPHWs conduct one-on-one interactions and use a mobile video clip for additional education. Participants self-collect vaginal swabs, which are analysed for HPV genotypes 16, 18, 31, and 45 using point-of-care testing. Positive results lead to colposcopy and treatment for suspicious lesions. A pilot study conducted in the first two weeks of the program screened 76 eligible women from the cohort. Results: Of the 76 women, 2 refused participation, and 16 were ineligible due to hysterectomy. Swabs were collected from 58 of 60 eligible women (96.67%), all of whom tested negative for HPV DNA. The majority of participants were aged 36-45, and only 5.17% had previously undergone cervical screening. Conclusions: Door-to-door screening by trained NPHWs has the potential to elicit high participation among rural women in India, demonstrating the feasibility of task-shifting in low-resource settings.