Venkataramanan Ramachandran

HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres?

Women living with HIV (WLHIV) face a six-to-tenfold increased risk of cervical cancer due to higher HPV prevalence and persistence. Despite an estimated 1.05 million WLHIV in India and a vast National AIDS Control Programme (NACP) network, no organized cervical screening exists within this infrastructure. This pilot implementation project aimed to demonstrate a feasible and efficacious model for integrating cervical cancer prevention services, including HPV screening and a 'see and treat' approach, for WLHIV within or near ART centres in hard-to-reach Indian settings. A total of 368 WLHIV aged >21 years on ART from three centres were invited. 314 (85.3%) were screened using the COBAS 6800 high-risk HPV test. HPV-positive women were recalled for colposcopy using a portable digital device. A 'see and treat' approach was applied, using thermal ablation or LLETZ for minor/major lesions suggestive of precancer in field clinics. 76 of 314 screened women (24.2%) tested positive for high-risk HPV. 65 of 76 HPV positive women (85.5%) complied with colposcopy and treatment. Histology from these 65 women showed 17 high-grade squamous intraepithelial lesions (HSIL), 23 low-grade SIL (LSIL), and 2 invasive cancers. The overall prevalence of HSIL or worse lesions was 5.7% among screened WLHIV. High participation was observed despite logistical challenges. The study confirms the significant burden of cervical neoplasia in WLHIV and demonstrates the feasibility and importance of integrating HPV screening and 'see and treat' services within or near existing ART centres using portable technologies. Leveraging the extensive NACP network offers a strategic opportunity for nationwide implementation, crucial for cervical cancer elimination efforts in this high-risk population.

Designing and Implementing a Cancer Screening Program for Underserved Tribal Women in Jharkhand

The status of cancer screening in India is concerning, especially in tribal states like Jharkhand, where the percentage of women who have ever undergone screening for cervical, breast, and oral cancer is 0.5, 0.1, and 0.2 percent, respectively. Adopting the community-led approach, Karkinos Healthcare, a purpose driven oncology platform, conducted a cancer screening program in collaboration with a livelihood-focused NGO in selected districts of Jharkhand. This study aims to describe the program's implementation and assess the program's performance vis a vis provision of care continuum from screening to treatment. The program was designed to provide comprehensive services including cancer awareness, enrolment for specialized cancer insurance for one year to cover the cost of treatment, risk assessment, screening for oral, breast, and cervical cancers, diagnostics to screen positive cases, and treatment to the confirmed cancer cases. A total of 16875 women underwent risk assessments, all of whom were invited for screening at community clinics. A total of 5993 women (34.9%) reported at community clinics and 5873 (34.9%), 5843 (34.7%), and 5029 (29.9%) underwent screening for oral, breast, and cervical cancer. 70% of the total HPV-positive cases had high-risk types other than HPV 16 and 18. 22.4% of the total screened women were navigated for advanced diagnostics and treatment among which 6 confirmed cases of cancer were reported. While the program design tried to address the implementation challenges like fragmented care, accessibility, and affordability of cancer care services, conversion from screening to treatment was limited.