Journal Article

Readiness to transition to HPV self-collection from VIA screening: a mixed methods health systems assessment from Tamil Nadu, India

Ashfaq, Maleeha, Singarayar, Pravin, Palaniraja, Sathishrajaa, Brotherton, Julia M.L., Basu, Partha, Ravikumar, Harini Sri, Selvinayagam, T.S., Viswanathan, Vidhya, D, Priya Ranjani, Muniswamy, Venugopal, Jeyapaul, Shalini, Kane, Sumit, Oommen, Anu Mary

2025

Overview

Background As a frontrunner in introducing cervical screening in India, the state of Tamil Nadu urgently needs to consider how to improve screening rates and switch to Human Papillomavirus (HPV) detection tests. Methods We used a mixed methods design to assess the readiness of the state health system for delivering the current cervical screening program, as well as for future HPV self-collection. Following a desk review, we surveyed 14 government health facilities in three districts of Tamil Nadu and calculated overall and domain-specific (service utilization, service availability, general service, cervical screening) readiness scores as percentages. We conducted four interviews and five focus group discussions with 37 participants [managers, primary care nurses, community health workers (CHWs)] to clarify findings and obtain suggestions regarding the introduction of HPV self-collection in tribal, rural, and urban low-resource settings. Results Scores for general services and readiness to offer visual inspection with acetic acid (VIA) and follow-up were more than 70% in the surveyed facilities. Despite the availability of trained nurses, infrastructure and resources, utilisation was primarily limited to symptomatic women attending health facilities due to poor acceptability of screening that would require facility visits. Most participants felt that self-collection could reduce women’s fear and embarrassment and could be delivered through CHWs in the community or by nurses at facilities. However, motivation for screening may remain low as most asymptomatic women do not perceive a need for screening, and/or fear implications of a positive test. Tertiary laboratories appear ready for HPV testing, given availability of high-throughput PCR equipment, computerised laboratory information management systems, and a planned hub and spoke model of improving access to laboratory tests. Conclusions Despite relatively good infrastructure and staffing for VIA screening in public healthcare facilities, service utilisation was primarily by symptomatic women, contributing to low screening rates. HPV self-collection was highly acceptable to administrative and field staff. Widespread educational approaches to motivate asymptomatic women to screen using self-collection, with decentralised sample collection and treatment, could potentially improve cervical screening rates. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adult / Cancer / Capacity assessment / Cervical cancer / Cervical cancer screening / Community health workers / Development of health services complex interventions / Diagnosis / Early Detection of Cancer - methods / Evaluation / Female / Focus Groups / Health Administration / Health facilities / Health Informatics / Health system / HPV detection test / Humans / India / Interviews as Topic / Mass Screening - methods / Medicine / Medicine & Public Health / Nursing Research / Papillomaviridae - isolation & purification / Papillomavirus infections / Papillomavirus Infections - diagnosis / Preparedness / Public Health / Self Care / Self-collection / Services / Specimen Handling - methods / Uterine Cervical Neoplasms - diagnosis / Uterine Cervical Neoplasms - virology