Translating Evidence into Practice in Low Resource Settings: Cervical Cancer Screening Tests are Only Part of the Solution in Rural India

Abstract

<b>Background:</b> The majority of women in rural India have poor or no access to cervical cancer screeningservices, although one–quarter of all cervical cancers in the world occur there. Several large trials have proventhe efficacy of low-tech cervical cancer screening methods in the Indian context but none have documented thenecessary components and processes of implementing this evidence in a low-resource setting. <br/><b>Methods</b>: Thispaper discusses a feasible model of implementation of cervical cancer screening programme in low-resourcesettings developed through a pilot research project carried out in rural Tamilnadu, India. The programmeused visual inspection of cervix after acetic acid application (VIA) as a screening tool, nurses in the primarycare centres as the primary screeners and peer educators within Self-Help Women groups to raise communityawareness. <br/><b>Results</b>: The uptake of screening was initially low despite the access to a screening programme.However, the programme witnessed an incremental increase in the number of women accessing screening withincreasing community awareness. <br/><b>Conclusions</b>: The investigators recommend 4 key components to programmeimplementation in low-resource setting: 1) Evidence-based, cost-effective test and treatment available within thereach of the community; 2) Appropriate referral pathways; 3) Skilled health workers and necessary equipment;and 4) Optimisation of health literacy, beliefs, attitudes of the community.