Public Health Research Institute of India, Mysore, India.
School of Medicine, University of California Irvine, Irvine, USA.
Asian Pac J Cancer Prev. 2021 May 1;22(5):1393-1400. doi: 10.31557/APJCP.2021.22.5.1393.
The aim of this study is to demonstrate the feasibility; mention the challenges encountered and highlight the success of implementing a community-based mobile cervical cancer-screening program in rural India.
Communities were mobilized through extensive peer education and by screening in existing community spaces using a mobile clinic model. An initial "screen and treat" protocol was transitioned to "screen, test, and treat" using Pap smears for confirmatory testing, and cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) for treatment. We trained 50 Peer Educators and conducted 190 screening camps in 58 locations.
Of 3,821 registered women, 3,544 (92.8%) accepted screening. Overall, 440/3544 (12.4%, 95% CI 11.3-13.5%) women had VIA-positive lesions. Under "screen and treat", 56/156 (35.9%) women accepted same-day treatment. Under "screen, test, and treat", 555/762 (72.8%) women received a Pap smear. Overall, 83 women underwent cryotherapy (n=56) and LEEP (n=27). Of those, 49 (59.0%) participants were followed up, with normal VIA results up to two years after treatment. In summary, the peer educators promoted awareness of cervical cancer and helped in gaining buy-in from communities. Acceptance of same-day treatment was low and accompanied by loss to follow-up, limiting the utility of VIA in these studies.
Mobile infrastructure utilized in community spaces brought screening directly to rural women. Culturally appropriate methods to increase linkage to treatment and additional screening options such as HPV DNA testing should be explored.
本研究旨在展示在印度农村实施基于社区的移动宫颈癌筛查计划的可行性；说明所遇到的挑战，并强调该计划的成功实施。
通过广泛的同伴教育和利用移动诊所模式在现有社区空间进行筛查，动员社区参与。最初的“筛查和治疗”方案过渡到“筛查、检测和治疗”，使用巴氏涂片进行确认性检测，以及使用冷冻疗法或环形电切术（LEEP）进行治疗。我们培训了 50 名同伴教育者，并在 58 个地点开展了 190 次筛查活动。
在注册的 3821 名妇女中，有 3544 名（92.8%）接受了筛查。总的来说，440/3544（12.4%，95%CI 11.3-13.5%）名妇女的 VIA 阳性病变。在“筛查和治疗”下，有 56/156（35.9%）名妇女接受了当天的治疗。在“筛查、检测和治疗”下，有 555/762（72.8%）名妇女接受了巴氏涂片检查。总的来说，有 83 名妇女接受了冷冻疗法（n=56）和 LEEP（n=27）治疗。其中，49 名（59.0%）参与者接受了随访，治疗后两年内 VIA 结果正常。总之，同伴教育者提高了对宫颈癌的认识，并帮助社区获得了认可。当天治疗的接受率较低，并伴有失访，这限制了 VIA 在这些研究中的应用。
在社区空间中利用移动基础设施将筛查直接带到了农村妇女身边。应该探索增加与治疗联系的文化上合适的方法，以及 HPV DNA 检测等额外的筛查选择。
