See Her Screen Her: An opportunistic VIA screening and HPV vaccination among female patient attendants at a tertiary cancer care center in a low-resource setting.

Abstract

e22518 Background: Cervical cancer remains one of the major causes of cancer mortality in low- and middle-income countries (LMICs) like Bangladesh, largely due to advanced stage at presentation, which is the result of low uptake of screening and HPV vaccination. This low uptake of screening is not only due to lack of access, but also due to fear, time constraints, inertia, and low risk perception. Female patient attendants at tertiary hospitals represent a large population with frequent hospital visits. Their hospital waiting time can be a natural setting for contextual nudges that reduce friction and increase preventive care uptake. We incorporated behavioral nudged-based strategies into an opportunistic visual inspection by acetic acid(VIA) screening, which is a very cost-effective option for cervical cancer screening in low resource setting, and HPV vaccination for female patient attendants visiting the oncology outpatients department, converting their waiting time into cervical cancer prevention time. Methods: We conducted a prospective, single-arm implementation study among female patient attendants aged 30-60 years attending outpatient departments, including chemotherapy day-care and radiotherapy waiting room at Ahsania Mission Cancer and General Hospital, from January,2025 to December,2025. Eligible female attendants were counseled and offered to do on-site VIA screening, which is free of cost. VIA-positive women navigated to colposcopy and biopsy accordingly. HPV vaccination was offered to eligible VIA-negative women, and they were encouraged to bring their other female relatives to do the same. The primary outcome was screening uptake, and the secondary outcomes were VIA positivity rate, detection of cervical intraepithelial neoplasia (CIN), invasive cervical cancer diagnosis, and HPV vaccination rate. Results: Over 12 months,2100 female attendants were approached, of whom 1680(80%) underwent VIA screening. VIA positivity was found in 420 women (25%).355 (85%) VIA-positive women completed their colposcopic evaluation. Among them, 60 women were found to have CIN I and CIN II. 10 patients were diagnosed with invasive cervical carcinoma. Among the VIA-negative women eligible for vaccination, 612 received at least 1 dose of HPV vaccine. This intervention substantially increased screening and vaccination coverage compared to the previous years. Conclusions: Opportunistic VIA screening with further navigation and HPV vaccination among female patient attendants is a feasible, effective, and scalable cervical cancer prevention strategy in low resource setting like Bangladesh. Implementing this novel strategy in other centers can meaningfully improve cervical cancer early detection and elimination efforts without additional infrastructure, stuffing and financial burden.