Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review |
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| Institution: | 1. Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA;2. Public Health Research Institute of India, Mysore, India;3. National Cancer Institute, Rockville, MD, USA;1. Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark;2. University Clinic for Innovative Patient Pathways, Silkeborg Hospital, Department of Clinical Medicine, Aarhus University, Falkevej 1-3, DK-8600 Silkeborg, Denmark;1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States;2. Comprehensive Cancer Center. University of Alabama at Birmingham, Birmingham AL, United States;3. University of Northern Colorado Cancer Rehabilitation Institute, Greeley, CO, United States;4. School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, United States;1. Gastrointestinal Unit, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland;2. Medical Oncology Unit, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland;3. Department of Pathology, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland;4. Department of Radiology, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland;1. Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Suite 5B, Lebanon, NH 03756, United States;2. The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States;3. Department of Surgery, Dartmouth Hitchcock Medical Center, United States;4. Department of Urology, Columbia University Medical Center, United States |
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| Abstract: | The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol’s Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6–82.6% and specificity ranged from 82.1–96.8%. Women between age groups of 30–59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level. |
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| Keywords: | Cervical cancer Screening Acetic acid Visual inspection Health planning Implementation India |
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