Strategies and implementation outcomes of HPV-based cervical screening studies to prevent cervical cancer in India: A systematic review

• Published in: Journal of cancer policy 2024-12, Vol.42, p.100513, Article 100513
• Main Authors: Oommen, Anu Mary, Ashfaq, Maleeha, Cherian, Anne George, Colling, Ana Machado, Ramirez, Arianis Tatiana, Saunders, Tessa, Singarayar, Pravin, Thomas, Vinotha, Thomas, Anitha, Marcus, Tobey Ann, Pricilla, Ruby Angeline, Nightingale, Claire, Brotherton, Julia ML
• Format: Article
• Language: English
• Subjects: Cervical; Early Detection of Cancer; Female; HPV; Humans; Implementation; India; India - epidemiology; Mass Screening; Papillomavirus Infections - diagnosis; Papillomavirus Infections - prevention & control; Review; Screening; Self-collection; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - virology
• ISSN: 2213-5383; 2213-5383
• DOI: 10.1016/j.jcpo.2024.100513

As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps. We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks. Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test. Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings. •There are no Randomised Controlled Trials comparing implementation strategies for Human Papillomavirus (HPV) self-collection in India.•There is a paucity of evidence regarding HPV screen-and-treat approaches.•HPV self-collection programs need to invest in better follow-up of the screen positive.•There is a lack of implementation research regarding HPV self-collection in tribal and north-eastern regions.