Pranay Tanwar

Novel Strategy of Training the Accredited Social Health Activists via Application-Based Telemedicine for Cervical Cancer Screening by Human Papillomavirus Self-Sampling: The TRACK Study

PURPOSE This pilot study is aimed to analyze a novel strategy of cervical cancer screening by training of Accredited Social Health Activist (ASHA) workers via telemedicine to counsel women for human papillomavirus (HPV) self-sampling. MATERIALS AND METHODS This is a pilot, community-based, prospective, single-arm study. Physicians trained the ASHA workers regarding self-sampled HPV testing via a mobile application and telephonically using videos and e-pamphlets, who in turn trained the clients in community. The HPV kits were transported via prepaid courier service. RESULTS Four hundred and sixty-five women of age group 30-65 years were tested by 47 teletrained ASHA workers. The mean age of ASHA worker and clients was 39.47 ± 6.45 and 37.26 ± 8.38 years, respectively. Of the ASHA workers, 91.7% were satisfied with the information provided during telecounseling, 95.7% could understand the contents of mobile app easily, and 93.6% could fill the data of clients in app easily. Of the clients, 99.6% were satisfied with counseling by ASHA workers and 98% found it easy to self-sample. The acceptability of this strategy among clients was 58.2%. The feasibility of this strategy (percentage of clients who find it easy/those who did self-sampling) was around 99%. Among those screened, 11.8% were high-risk HPV-positive and 85.5% had follow-up at the study center. CONCLUSION The current study highlights a novel strategy of cervical cancer screening by incorporating the role of telemedicine in training ASHA workers and their role in improving the screening by home-based delivery of HPV kits with promising results.

Evaluating The Feasibility and Acceptability of Cervical Cancer Screening in an Urban Slum Community by HPV Self-Sampling With the Aid of Telecounselling: Lessons Learnt

HPV testing is the most sensitive method of secondary cervical cancer prevention and the preferred method recommended by the World Health Organization. To increase cervical cancer screening, self-sampling has been introduced, which has shown significant results in improving access and simplifying screening for large and remote populations in low- and middle-income countries. This study aims to evaluate the feasibility and acceptability of HPV self-sampling in an urban slum community using tele-counselling, which is a niche population for HPV positivity and HPV-related diseases. This study is a community-based, prospective, single-arm design. Women were counselled telephonically about the methods of self-sampling, and HPV self-sampling kits were couriered to them. The collected kits were returned via courier and tested at the study site. In the case of a positive test result, the individual was linked to treatment at the study center. Test positives were offered either a 'see and treat' approach or colposcopy triage. In the community, 982 women were enrolled in the study, but only 600 (61%) women consented to screening by HPV self-sampling. Ninety-six (15.6%) out of 600 women tested positive for Hr-HPV. Age, educational status, locality, occupation, menopausal status, and smoking status were similar in both screen-negative and screen-positive groups. Among the 600 women, 570 (95%) found it easy to take a self-sample, and 588 (98%) were satisfied with the overall experience. CIN I was found in 6 (6.4%), and CIN II was found in 4 (4.3%) cases. LEEP was performed in patients diagnosed with CIN II. HPV self-sampling is an acceptable method of cervical cancer screening, with an acceptance rate of 61% among urban slum women. It demonstrates that HPV self-sampling is feasible when supported by tele-counselling.