Implementation science insights from a community-embedded cervical cancer screening program integrating high-risk human papillomavirus DNA testing with non-communicable disease screening in rural South India.

Abstract

1509 Background: The WHO Cervical Cancer Elimination Initiative recommends screening ≥70% of eligible women and linking ≥90% of those with identified disease to treatment. However, in most low- and middle-income countries (LMICs), screening rate remains around 30–40%, and only 40–60% of high-risk human papillomavirus (HR-HPV)–positive women complete colposcopy thereby precluding identification of disease and linking to treatment. To address this gap across the screening–diagnosis–treatment pathway, we implemented a multi-pronged community-based program integrating community participation, self-swab HR-HPV DNA screening at doorsteps, with non-communicable disease (NCD) screening and patient centric treatment linkage. Methods: This longitudinal implementation study was conducted within the Rural Effective Affordable Comprehensive Health (REACH) cohort in Medchal district, Telangana, India. Trained non-physician health workers conducted door-to-door outreach among women aged 25–65 years. Community engagement was supported by a local Community Advisory Board and village influencers, who guided outreach strategies and timing. Counseling and self-collection of vaginal samples were carried out at participants’ homes. Educational content was developed based on prior formative research using the Health Belief Model to address fears, stigma, and misconceptions. Screening for HR-HPV DNA was offered as part of a bundled women’s health package that included blood pressure and diabetes testing. Appointments for both swab collection and colposcopy/biopsy were coordinated and scheduled at the convenience of the community. HR-HPV testing was done using a chip-based PCR platform. Women who tested positive were referred for colposcopy, biopsy, and treatment at an affiliated teaching hospital. Results: Of 1,869 women approached, 1,747 (93.5%) completed HR-HPV self-sampling, surpassing the WHO’s 70% screening target. HR-HPV was detected in 89 women (5.1%). Of these, 64 (71.9%) underwent colposcopy, higher than LMIC averages. All with abnormal findings had biopsies. Four women were diagnosed with high-grade lesions or early invasive cancer, all successfully linked to definitive care or referral, meeting the WHO ≥90% treatment linkage benchmark. Conclusions: Integrating HR-HPV screening with NCD services, enabled by community leadership, doorstep access, and logistical support, achieved high coverage, improved follow-up, and complete linkage to care. This model offers practical, scalable insights for cervical cancer screening programs in rural, resource-limited settings.