Experience of a 'Screen and treat' program for secondary prevention of cervical cancer in Uttar Pradesh, India

Aim: Considering the burden of cervical cancer in India, innovative approaches are needed to improve coverage of cervical cancer screening.

Methods: From May 2014 to January 2017, we implemented a project in 10 cities in Uttar Pradesh, India using World Health Organization-recommended 'screen and treat' approach for cervical cancer prevention. We involved private practitioners (obstetricians and gynecologists and general practitioners) in these cities to provide affordable cervical cancer screening to women mobilized by our community health workers. A pilot phase was implemented in three cities during May 2014 and December 2015 and the project was scaled-up to additional seven cities between January 2016 and January 2017.

Results: A total of 100 836 women aged between 30 and 60 years were screened with visual inspection with acetic acid (VIA) of which 5477 (5.4%, 95% confidence interval (CI) 5.29, 5.57) were VIA positive. Treatment with cryotherapy was given to 3735 (68.2%, 95% CI 66.96, 69.43) women. In the three cities that piloted the program, VIA positivity rates significantly declined from 6.6% (95% CI 6.31, 6.84) to 4.0% (95% CI 3.82, 4.24) during the scale-up phase (P < 0.0001) and the rates of cryotherapy significantly increased from 66.8% (95% CI 64.78, 68.77) to 76.7% (95% CI 74.42, 78.96) (P < 0.0001).

Conclusion: We observed a significant decline in the VIA positivity rates during the scale-up phase in the three cities that participated in the pilot phase. We have reported successful engagement of private practitioners to provide affordable cervical cancer screening and it is possible to replicate it in other states in India as well.