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Cited by 0Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Integrating a “see-and-treat” approach with opportunistic human papilloma virus deoxyribonucleic acid (HPV DNA) based cervical cancer screening in India: a retrospective cross-sectional study

Open access
Rao, Sripriya, Chhabra, Mayank, Kudkuli, Jagadish, Toraskar, Milan, Nath, Aswathy G., Prakash, Devu, Srivastava, Shweta, Imo Singh, Wahengbam +4 more·2026·AJOG Global Reports
DOI 10.1016/j.xagr.2026.100678PMC PMC13524459
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Abstract

BACKGROUND: India lacks an organized national cervical cancer screening program, and while the World Health Organization (WHO) recommends human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing as the primary modality, large-scale evidence on implementation via decentralized treatment pathways in India is limited. We evaluated the effectiveness of opportunistic high-risk HPV (hrHPV) DNA screening, assessing prevalence, genotype distribution, self-testing acceptance, and the diagnostic performance of a community-based "see-and-treat" approach. OBJECTIVE: To evaluate the prevalence and genotype distribution of hrHPV and assess the diagnostic accuracy, treatment compliance, and clinical viability of a decentralized "see-and-treat" approach within a large-scale opportunistic screening program across 20 Indian states. STUDY DESIGN: In this retrospective cross-sectional study (January 2022-December 2025), 62,868 women aged 25 to 65 years were enrolled across 20 Indian states via community outreach (75.1%) and hospital-based network (24.9%). Screening utilized clinician-collected or self-collected (10.5%) samples tested via the Cobas 6800 system. hrHPV-positive women were triaged by colposcopy and managed through a decentralized "see-and-treat" approach using thermal ablation (TA) or Large Loop Excision of the Transformation Zone (LLETZ). Primary outcomes included HPV prevalence, diagnostic accuracy (AUC), and treatment compliance. RESULTS: Overall HPV prevalence was 8.5% (5,354/62,868), with significant regional variation (11.3% in Delhi NCR to 4.7% in Kerala). Non-16/18 high-risk genotypes accounted for 54.6% of infections. Positivity peaked at ages 26 to 30 years (10.1%) and had a minor peak at 51 to 55 years (8.4%). The see-and-treat modality demonstrated high diagnostic accuracy (AUC 0.95; sensitivity 0.98; specificity 0.91) with a program efficacy of 81.2% with 16.3% overtreatment and 21.1% undertreatment. Treatment compliance in the community sub-cohort was 51.3% (1,957/3,813). We identified five women with invasive cancers and 7.8% CIN III (28/357), 9.0% CIN II (32/357), and 26.3% CIN I (94/357) of the histopathology sub-group. CONCLUSION: Opportunistic hrHPV screening integrated with decentralized "see-and-treat" is a clinically robust strategy for LMICs. Significant regional heterogeneity requires tailored, state-specific policies and digital linkage-to-care frameworks to overcome compliance barriers and meet WHO 2030 cervical cancer elimination goals.

AI snapshot

Written from the paper’s full text.

TL;DR

In a retrospective cross-sectional opportunistic screening program across 20 Indian states, 62,868 women aged 25–65 had an hrHPV prevalence of 8.5%, with non-16/18 genotypes accounting for 54.6% of infections. A decentralized “see-and-treat” approach showed high diagnostic accuracy (AUC 0.95; sensitivity 0.98; specificity 0.91), but community treatment compliance was 51.3%.

Key findings

  • Overall hrHPV prevalence was 8.5% (5,354/62,868), ranging from 11.3% in Delhi NCR to 4.7% in Kerala; positivity peaked at 10.1% in ages 26–30 and had a minor peak of 8.4% at ages 51–55.
  • Non-16/18 high-risk genotypes accounted for 54.6% (2,922/5,354) of infections; HPV 16 was 24.2%, HPV 18 was 9.8%, and combinations were 11.4%.
  • The see-and-treat modality had AUC 0.954, sensitivity 0.98 (95% CI 0.93–1.00), specificity 0.91 (95% CI 0.81–0.97), PPV 0.95, and NPV 0.96; program efficacy was 81.2%, with 16.3% overtreatment and 21.1% undertreatment.
  • Treatment compliance in the community sub-cohort was 51.3% (1,957/3,813); histopathology (n=357) found 5 (1.4%) invasive cancers, 7.8% CIN III, 9.0% CIN II, and 26.3% CIN I; self-sampling uptake was 10.5% (6,602) with 6.8% HPV positivity.

Methods

  • Retrospective cross-sectional study from January 2022 to December 2025 enrolling 62,868 women aged 25–65 across 20 Indian states via community outreach (75.1%; n=47,202) and hospital-based networks (24.9%; n=15,666); women with known HIV, commercial sex work, or incarceration were excluded.
  • Screening used clinician-collected or self-collected samples tested on the Cobas 6800 system; hrHPV-positive women were triaged by colposcopy and managed through decentralized see-and-treat using thermal ablation or LLETZ, while hospital-based screen-positive women were managed independently by gynecologists.
  • Analyses included descriptive, bivariate, and multivariate methods with crude and adjusted odds ratios and 95% CIs; Pearson correlation between colposcopy and histopathology; AUC, sensitivity, and specificity; SPSS and R were used with p<0.05 considered significant.

Limitations

  • Stated in the paper: convenience sampling may underrepresent underserved or rural areas; absence of sexual history and lifestyle data prevents granular behavioral risk analysis; and a 6-month follow-up period precludes assessment of long-term cancer incidence reduction.
  • Evident from the text: hospital-based screen-positive women were managed independently without study SOPs, limiting comparability with the decentralized see-and-treat protocol; self-sampling versus nurse-assisted follow-up data were not segregated.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.xagr.2026.100678

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

24 of 40 cited sources checked · 4 supported · 3 flagged · accuracy not yet measured

  • Premisecitation

    India lacks a national, organized cervical cancer screening program.

    “India lacks a national, organized screening program, leaving most women without access to preventive care.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [2] Cotton, 2007, Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women, Br J Cancer source

      The Study population and Discussion sections describe UK national cervical screening programmes, not screening in India. The Discussion’s Smear status section mentions India only in a comparison of HPV prevalence. Searches for an Indian national screening programme and women’s access to preventive care found no passage addressing the claim; page numbers were unavailable. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [3] WHO. Cervical cancer – facts sheet. Geneva, 2024https://www.who.int/news-room/fact-sheets/detail/cervical-cancer (accessed May 7, 2025).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] Bhatla, 2021, Cervical cancer prevention efforts in India, Indian J Gynecol Oncol source

      The National Programmes for Cancer Control section says India’s National Cancer Control Programme includes cervical cancer screening and describes a screening strategy at primary, secondary and tertiary levels. The paper identifies implementation gaps, but it does not say India lacks a national programme for cervical screening. (LLM, conf=0.79)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Interpretationcitation

    These results reinforce the findings of anchor trials (Sankaranarayanan et al) that established the superior sensitivity of HPV molecular testing over VIA or cytology.

    “These results reinforce the findings of anchor trials (Sankaranarayanan et al) that established the superior sensitivity of HPV molecular testing over VIA or cytology.9,10,22”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites Sankaranarayanan et al

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [9] Sankaranarayanan, 2009, HPV screening for cervical cancer in rural India, N Engl J Med source
    • cites [10] Rositch, 2013, The correlation between human papillomavirus positivity and abnormal cervical cytology result differs by age among perimenopausal women, J Low Genit Tract Dis source

      The Methods describe HPV DNA testing and Pap cytology, but do not compare their sensitivity or evaluate VIA. The Discussion says the study lacked pathologic confirmation needed to clarify differences in sensitivity and specificity (page unavailable). Searches for VIA and the named trials found no passage supporting the attributed finding. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [22] Sankaranarayanan, 2005, A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India, Int J Cancer source

      The Discussion says this trial found that HPV testing did not improve detection of high-grade lesions over good-quality cytology. The Intermediate outcome evaluation reports similar detection rates across the HPV, VIA, and cytology arms. Although the Discussion notes that other studies suggest higher HPV sensitivity than cytology, it does not present that as this trial’s finding. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    The absence of data on sexual history and lifestyle prevents granular analysis of behavioral risks.

    “The absence of data on sexual history and lifestyle prevents granular analysis of behavioral risks,2,10 and a 6-month follow-up period precludes assessment of long-term cancer incidence reduction.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [2] Cotton, 2007, Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women, Br J Cancer source

      The Discussion says the study did not collect numbers of sexual partners or age at first intercourse, limiting analysis of sexual-behaviour risks. But the Questionnaire section says it collected lifestyle data, including smoking and physical activity, so the claimed absence of lifestyle data is not supported. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [10] Rositch, 2013, The correlation between human papillomavirus positivity and abnormal cervical cytology result differs by age among perimenopausal women, J Low Genit Tract Dis source

      The Methods (Study population and data collection) say the study collected lifetime sexual history and current sexual behavior, contrary to the claimed absence of sexual-history data. The Discussion also reports an age-stratified association between HPV detection and lifetime number of sex partners. Our copy does not establish whether other lifestyle data were available. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The HPV positivity prevalence aligns with regional estimates ranging between 5% and 15%.

    “The HPV positivity prevalence aligns with regional estimates, ranging between 5% and 15%.2,16, 17, 18, 19, 20, 21”
    Quote in the paperNot a substantial claim6 of 7 sources checked
    • cites [2] Cotton, 2007, Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women, Br J Cancer source
    • cites [16] Mitchell, 2014, Factors associated with high-risk HPV positivity in a low-resource setting in sub-Saharan Africa, Am J Obstet Gynecol source
    • cites [17] Mittal, 2024, High-risk HPV prevalence estimates among older patients: implications for cervical cancer screening programs, Indian J Community Med source

      The Discussion reports several regional HPV prevalence estimates within 5%–15%, including 7.1% for Southern Asia and 9.9% for Eastern India. It does not establish 5%–15% as the regional range: the Introduction gives a wider range of 2.3%–36.9% for India, and the study's own estimate is 4.90%. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [18] Parvez, 2024, A population based study on human papillomavirus infection and associated risk factors among women of the remote South Andaman Island, India, BMC Womens Health source

      The Results report HPV prevalence of 5.0% crude and 5.9% adjusted, and the Discussion says the study's estimate is similar to those in Indian community-based studies. The Discussion does not give a regional range of 5%–15%; it reports wider Indian ranges, including 2.3%–36.9%. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [19] Zhao, 2010, Performance of high-risk human papillomavirus DNA testing as a primary screen for cervical cancer: a pooled analysis of individual patient data from 17 population-based studies from China, Lancet Oncol source

      The Results report regional HPV DNA positivity of 7.9% in urban areas and 6.9% in one rural area, both within the cited 5%–15% range. But the pooled estimate was 16.3% and the rural estimate was 17.1%, so this paper does not support that range as a general description of its regional estimates. No page number is available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [20] Origoni, 2012, HPV-DNA testing for cervical cancer precursors: from evidence to clinical practice, Ecancermedicalscience source

      The ‘HPV testing in primary screening’ section gives a 2%–7% range for positive cytology results, not HPV positivity. Searches for HPV prevalence and the 5%–15% range found no passage in our copy reporting the claimed regional estimates. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [21] Bhatla, 2025, Cancer of the cervix uteri: 2025 update, Int J Gynaecol Obstet source

      The primary prevention section reports a global HPV prevalence of approximately 11.7% among healthy women over 30, which falls within the claimed range. It does not give a regional range of 5%–15%; instead, it reports approximately 24% for sub-Saharan Africa and a country-specific range of 2%–42% globally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Findingown data

    9.0% of the histopathology sub-group had CIN II (32/357).

    “We identified five women with invasive cancers and 7.8% CIN III (28/357), 9.0% CIN II (32/357), and 26.3% CIN I (94/357) of the histopathology sub-group.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 35
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The efficacy of opportunistic screening strategies is often mediated by complex socio-demographic disparities.

    “However, the efficacy of these strategies is often mediated by complex socio-demographic disparities.”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [13] Muthuramalingam, 2023, Patterns in the prevalence and wealth-based inequality of cervical cancer screening in India, BMC Womens Health source

      The Discussion says that understanding socio-demographic and economic differences in screening prevalence is key to achieving target screening levels. It also mentions a facility-based opportunistic program in Tamil Nadu, but does not assess whether those disparities mediate that program’s efficacy. The Results report differences in screening prevalence, not strategy efficacy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [14] Ghosh, 2021, Knowledge, attitude and practices towards cervical cancer and its screening among women from tribal population: a community-based study from southern India, J Racial Ethn Health Disparities source

      The Results (page unavailable) associate cervical-cancer screening knowledge with education, socioeconomic status and tribal community. They also report that none of the 945 participants had undergone screening, so the study does not establish that these disparities mediate the efficacy of opportunistic screening strategies. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [15] Changkun, 2022, Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women, PLoS One source

      The Discussion (page unavailable) says sociodemographic factors are associated with, and can constrain, cancer-screening uptake among Indian women. It does not specifically study opportunistic screening or measure strategy efficacy; it also cautions that its cross-sectional data cannot establish causal effects. Thus it supports the disparity point, but not the claim that disparities mediate the efficacy of those strategies. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Clinically validated high-performance molecular tests like hrHPV DNA tests that meet established international performance criteria, such as those defined by Meijer et al and verified through the VALGENT framework, are recommended.

    “Key recommendations emphasize the use of clinically validated high-performance molecular tests like hrHPV deoxyribonucleic acid (DNA) tests that meet established international performance criteria, such as those defined by Meijer et al and verified through the VALGENT framework.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [11] Meijer, 2009, Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older, Int J Cancer source

      The Requirements and Validation guidelines sections (page not available) define clinical-performance criteria for hrHPV tests in primary screening of women aged at least 30 and recommend validating candidate tests against a clinically validated reference test. The paper describes its guidelines as a proposal seeking international consensus; our copy does not say the criteria were verified through the VALGENT framework. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [12] Arbyn, 2016, VALGENT: a protocol for clinical validation of human papillomavirus assays, J Clin Virol source

  • Classified as probably not a substantial claim.

    Premisecitation

    HPV is a primary contributor to the development of cervical cancer.

    “Human papillomavirus (HPV) is recognized as a primary contributor to the development of cervical cancer.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] Cotton, 2007, Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK women, Br J Cancer source

  • May combine two claims.

    Interpretationown data

    The see-and-treat model achieved a sensitivity of 0.98 and specificity of 0.91, meeting international clinical validation criteria and WHO targets for appropriate management.

    “Our “see-and-treat” model (Figure 3) achieved a sensitivity of 0.98 and specificity of 0.91, meeting international clinical validation criteria11 and WHO targets for appropriate management.8”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [11] Meijer, 2009, Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older, Int J Cancer source

      The “Validation guidelines for candidate HPV assays” section sets clinical validation criteria for HPV DNA tests in women aged 30 and older, including sensitivity and specificity relative to the hc2 reference test. It does not evaluate the citing authors’ see-and-treat model or establish that its reported sensitivity of 0.98 and specificity of 0.91 meet those comparative criteria. The WHO-target portion is attached to a different citation. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [8] WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva, 2020 https://iris.who.int/server/api/core/bitstreams/4e245e89-ddcc-488f-97c7-9de5e08524ef/content (accessed March 18, 2026).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mathur's cross-sectional analysis of 43 population-based cancer registries reveals a similar spectrum of geographic heterogeneity, with age-adjusted incidence rates showing nearly seven-fold variations across different Indian districts.

    “Mathur’s cross-sectional analysis of 43 population-based cancer registries reveals a similar spectrum, with age-adjusted incidence rates showing nearly seven-fold variations across different Indian districts.1”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Mathur, 2025, Cancer incidence and mortality across 43 cancer registries in India, JAMA Netw Open source

  • The quote only partly states this claim.

    Interpretationown data

    Self-sampling is viable in bypassing socio-cultural barriers and stigma associated with pelvic exams.

    “This approach serves as a tool for patient empowerment in the Indian context, bypassing the lack of autonomy often experienced in seeking clinician/nurse-led care.26,27”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [26] Dhanasekaran, 2022, Challenges in setting up a primary human papillomavirus-DNA testing facility in a lower and middle income country: lessons learned from a pilot programme, Ecancermedicalscience source

      The Methods (page not provided) describe women collecting HPV samples privately at home rather than having a clinician collect them. The Discussion (page not provided) mentions fear and shyness as screening barriers, but does not establish that self-sampling bypasses stigma associated with pelvic exams or a lack of autonomy in seeking clinician- or nurse-led care. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [27] Hariprasad, 2024, Cost-utility analysis of primary HPV testing through home-based self-sampling in comparison to visual inspection using acetic acid for cervical cancer screening in East district, Sikkim, India, 2023, PLoS One source

      The Discussion (page unavailable) says home-based HPV self-sampling overcomes barriers to screening and that women prefer collecting samples at home rather than visiting a facility. It does not identify socio-cultural stigma around pelvic exams or lack of autonomy in seeking clinician-led care as barriers that self-sampling bypasses. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Our findings align with global evidence suggesting self-sampling reduces logistical burdens in rural areas.

    “While specific comprehensive follow-up data between self-sampling and nurse-assisted methods were not segregated, our findings align with global evidence suggesting self-sampling reduces logistical burdens in rural areas.26,28,29”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [26] Dhanasekaran, 2022, Challenges in setting up a primary human papillomavirus-DNA testing facility in a lower and middle income country: lessons learned from a pilot programme, Ecancermedicalscience source

      The Methods (page not provided) describe women self-collecting samples at home in mountainous Sikkim, where travel is difficult. But the Results report costly sample transport and do not compare logistical burdens with nurse-assisted sampling. The paper therefore supports the relevance of home self-sampling in a hard-to-reach setting, not the broader claim that it reduces logistical burdens in rural areas. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [28] Gopalkrishnan, 2025, Addressing global disparities in cervical cancer burden: a narrative review of emerging strategies, Curr HIV/AIDS Rep source
    • cites [29] Adsul, 2019, A community-based, cross-sectional study of hrHPV DNA self-sampling-based cervical cancer screening in rural Karnataka, India, Int J Gynaecol Obstet source

      The Introduction (page unavailable) says self-collection moves primary screening from the clinic into the community, and the Discussion says it may improve access for hard-to-reach populations. That supports a potential reduction in the burden of reaching a clinic, but the paper does not establish an overall reduction in logistical burdens; its Discussion describes follow-up as resource-intensive and challenging. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    HPV positivity varied significantly across participating states, with the highest rates in Delhi NCR (11.3%), Tamil Nadu (9.6%), and Jharkhand (9.3%), and the lowest in Kerala (4.7%).

    “Significant regional variations were observed across the participating states where the highest positivity rates were seen in Delhi NCR (11.3%), followed by Tamil Nadu (9.6%) and Jharkhand (9.3%) (Table 1), while Kerala (4.7%) reported the lowest positivity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPV positivity declined from 10.1% in women aged 26 to 30 years to 7% in those aged 61 to 65 years, with a minor peak at 51 to 55 years.

    “HPV positivity demonstrated a consistent decline from 10.1% in women aged 26 to 30 years to 7% in those aged 61 to 65 years with a minor peak observed at 51 to 55 years (Figure 1, A).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Self-sample collection was done by 10.5% of women (n=6,602), predominantly in the community setting (87.4%).

    “The self-sample collection was done by 10.5% women (n=6,602), which was predominantly in the community setting (87.4%) within Delhi NCR (n=2,265), Kerala (n=1,774), and Maharashtra (n=1,102).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPV positivity peaked at ages 26 to 30 years, with a prevalence of 10.1%.

    “Positivity peaked at ages 26 to 30 years (10.1%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HPV positivity was 8.1% in the community-based sub-cohort (n=47,202) and 9.8% in hospital-based screening (n=15,666).

    “Furthermore, within the community-based sub-cohort (n=47,202), the positivity rate was 8.1% (n=3,813), while screenings conducted in hospital settings (n=15,666) yielded higher positivity (9.8%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In this retrospective study of 62,868 women, hrHPV prevalence was 8.5%, with 54.6% of infections caused by non-16/18 genotypes.

    “This retrospective study of 62,868 women represents an evaluation of opportunistic hrHPV DNA screening in India, 8.5% prevalence with a notable 54.6% of infections caused by non-16/8 genotypes (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the colposcopy cases, 85.7% were managed through TA and 14.2% through LLETZ.

    “These cases were further managed through TA in 85.7% of patients and LLETZ in 14.2%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The overall sample was stratified by screening environment, with 75.1% (N=47,202) recruited via community outreach extension clinics and 24.9% (N=15,666) enrolled through hospital-based services.

    “The overall sample was stratified by screening environment, with 75.1% (N=47,202) of participants recruited via community outreach extension clinics and 24.9% (N=15,666) enrolled through hospital-based services.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The prevalence of CIN III was consistent between women aged 26 to 55 years (around 9%), while prevalence of CIN II and I was highest in the 56 to 65 years age cohort (around 43%) and lowest in 51 to 55 years women (26.2%).

    “The prevalence of CIN III was observed to be consistent between women aged 26 to 55 years (around 9%), while prevalence of CIN II and I was highest in the 56 to 65 years age cohort (around 43%) and lowest in 51 to 55 (26.2%) years women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On histopathology (n=357), 5 (1.4%) women had features of invasive squamous cell carcinoma; 43.1% had CIN (CIN III 28 [7.8%], CIN II 32 [9.0%], CIN I 94 [26.3%]); 84 (23.6%) had chronic cervicitis; and 114 (31.9%) were normal.

    “On histopathology (n=357) findings suggest 5 (1.4%) women with features of invasive squamous cell carcinoma, 43.1% women with Cervical Intraepithelial Neoplasia (CIN III in 28 [7.8%], CIN II in 32 [9.0%], and CIN I in 94 [26.3%]), 84 (23.6) women with chronic cervicitis, and 114 (31.9%) women were normal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The highest rates of treatment compliance were observed in women aged 41 to 60 years (exceeding 53.0%), whereas the lowest compliance was recorded among those aged 26 to 30 years (39.1%).

    “The highest rates of treatment compliance were observed in women aged 41 to 60 years (exceeding 53.0%), whereas the lowest compliance was recorded among those aged 26 to 30 years (39.1%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The overall program efficacy was 81.2%, with an overtreatment rate of 16.3% and an undertreatment rate of 21.1%.

    “The overall program efficacy was 81.2%, with a calculated overtreatment rate of 16.3% and an undertreatment rate of 21.1%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among women who underwent colposcopy (n=444), 81 (18.2%) were diagnosed with HSIL, 128 (28.8%) with LSIL, 74 (16.7%) with inflammation/cervicitis or metaplasia, and 161 (36.3%) were normal.

    “The colposcopy findings (n=444) highlight that 81 (18.2%) women were diagnosed with high-grade squamous intraepithelial lesions (HSIL), 128 (28.8%) women with low-grade squamous intraepithelial lesions (LSIL), 74 (16.7%) women with inflammation/cervicitis or metaplasia, and the rest, 161 (36.3%), were normal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Treatment compliance remains the same throughout HPV type specificity.

    “The treatment compliance remains the same throughout the HPV type specificity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Our findings identify a bimodal distribution of hrHPV positivity, characterized by a primary peak of 10.1% in younger women aged 26 to 35 years and a secondary peak of 8.4% among perimenopausal women aged 51 to 55 years.

    “Our findings identify a bimodal distribution of hrHPV positivity, characterized by a primary peak of 10.1% in younger women aged 26 to 35 years and a secondary peak of 8.4% among the perimenopausal women aged 51 to 55 years (Figure 1, A; Table 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The see-and-treat system demonstrated a sensitivity of 0.98 (95% CI 0.93-1.00) and a specificity of 0.91 (95% CI 0.81-0.97).

    “The system demonstrated a sensitivity of 0.98 (95% CI: 0.93–1.00) and a specificity of 0.91 (95% CI: 0.81–0.97).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Genotypic analysis of the invasive malignancies revealed three cases associated with HPV 16, one with HPV 16 and other high-risk, and one with a non-16/18 hrHPV genotype.

    “Genotypic analysis of these malignancies revealed that three cases were associated with the HPV 16 genotype, one case was linked to HPV 16 and other high-risk, while one was linked to a non-16/18 hrHPV genotype.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The see-and-treat system had a PPV of 0.95 and an NPV of 0.96.

    “The PPV was 0.95, while the negative predictive value (NPV) was 0.96.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The prevalence of CIN III-I was high in HPV 16 (52.1%) and combination of infection with HPV 16 (52.9%).

    “The prevalence of CIN III-I was high in HPV 16 (52.1%) and combination of infection with HPV 16 (52.9%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Geographically, CIN III prevalence was notably high in Jharkhand (22.6%) and least in Kerala (3.0%), whereas prevalence of CIN II and I was high in Kerala (51.5%) and Tamil Nadu (44.4%).

    “Geographically, CIN III prevalence was notably high in Jharkhand (22.6%) and least in Kerala (3.0%), whereas prevalence of CIN II and I was high in Kerala (51.5%) and Tamil Nadu (44.4%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In hospital-based settings, HPV 16 and 18 genotypes exhibited a higher proportional peak (49.3%), with peaks for HPV 16 (26.1%) and HPV 18 (11.6%).

    “With respect to the collection setting, Figure 2, C shows that HPV 16 and 18 genotypes exhibited a higher proportional peak in hospital-based settings (49.3%) with peaks for both HPV 16 (26.1%) and HPV 18 (11.6%) and community-based collection has high prevalence of HPV others (56.1%) genotype.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Significant regional variations in HPV prevalence and treatment are observed.

    “Significant regional variations in HPV prevalence and treatment are observed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Compliance fluctuated with state-level health and economic indicators, being higher in Tamil Nadu (79.3% compliance; Health Index 64.1; literacy rate 85.5) and lower in Jharkhand (17.7% compliance; Health Index 48.2; literacy rate 76.7).

    “Compliance fluctuated with state-level health and economic indicators, being higher in Tamil Nadu (79.3% compliance; Health Index 64.1; literacy rate 85.5) and lower in Jharkhand (17.7% compliance; Health Index 48.2; literacy rate 76.7).24,25”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [24] Ministry of Statistics and Programme Implementation. Periodic labour force survey 2023–24: literacy and educational indicators. New Delhi, 2024https://www.mospi.gov.in/sites/default/files/publication_reports/AnnualReport_PLFS2023-24L2.pdf (accessed March 5, 2026).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [25] NITI Aayog. Healthy states, progressive India: report on the ranks of states and union territories – health index. 2021https://www.niti.gov.in/sites/default/files/2021-12/NITI-WB_Health_Index_Report_24-12-21.pdf (accessed March 5, 2026).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Formal ethical approval was granted by Karkinos Healthcare Independent Ethics Committee (KH-IEC) with Protocol No. KH-IEC/04/2025.

    “Formal ethical approval was granted by Karkinos Healthcare Independent Ethics Committee (KH-IEC) with a Protocol No. KH-IEC/04/2025”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WHO advocates for a "90-70-90" target, requiring 70% screening coverage using high-performance HPV molecular tests twice in a lifetime, by ages 35 and 45.

    “The WHO advocates for a “90-70-90” target, requiring 70% screening coverage using high-performance HPV molecular tests twice in a lifetime, by ages 35 and 45.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva, 2020 https://iris.who.int/server/api/core/bitstreams/4e245e89-ddcc-488f-97c7-9de5e08524ef/content (accessed March 18, 2026).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Screening and HPV sample collection were undertaken with written informed consent before the procedures.

    “Screening and HPV sample collection were undertaken with the written informed consent before the procedures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Further informed written consent was deployed for HPV-positive women before navigating them to "see-and-treat" modality.

    “Further informed written consent was deployed for HPV-positive women before navigating them to “see-and-treat” modality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    CC team-based patient follow-up, dedicated counsellor, and grass-root mobilizer making three calls for every participant strictly adhered to standard SOPs.

    “CC team-based patient follow-up, dedicated counsellor, grass-root mobilizer making three calls for every participant was strictly adhered to standard SOPs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The high diagnostic precision (AUC 0.95) of our triage stands in contrast to regional pilots, such as in Uzbekistan, where lower correlations between colposcopy and histopathology limited program efficacy (correlation only 53.2%).

    “The high diagnostic precision (AUC of 0.95; Figure 3) of our triage stands in contrast to regional pilots, such as in Uzbekistan, where lower correlations between colposcopy and histopathology limited program efficacy (correlation between diagnostic colposcopy and histopathology was only 53.2%).23”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Zahirova, 2026, Lessons learned from evaluation of a human papillomavirus screening pilot in Uzbekistan, JCO Glob Oncol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The sample size was determined by the total participation in opportunistic HPV screening during the 4-year study period, not by a priori calculation.

    “As this was a retrospective evaluation of an opportunistic screening program, the sample size was determined by the total participation in opportunistic HPV screening through integrated community and hospital-based services during the 4-year study period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The researchers exercised sole responsibility for the study design, data analysis, and manuscript preparation independent of the institutions that provided financial resources.

    “The researchers exercised sole responsibility for the study design, data analysis, and manuscript preparation independent of the institutions that provided the financial resources for the program’s execution.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    Our study yielded higher diagnostic accuracy and PPV than regional pilots.

    “Furthermore, our study (Figure 3) yielded higher diagnostic accuracy and PPV.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Hospital-based screen-positive women were managed independently by gynecologists following their own clinical recommendations or protocols, with no SOPs given by the study investigators.

    “Hospital-based screen-positive women were directly managed by gynecologists independently following their own clinical recommendations or protocols; no SOPs were given by the study investigators.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The Cobas 6800 system ensures high NPV, supporting the safe extension of screening intervals.

    “The Cobas 6800 system ensures high NPV, supporting the safe extension of screening intervals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The successful identification and clinical management of 723 individuals with precancerous cervical lesions informs that the integration of high-quality diagnostic triaging with immediate intervention, yielding an overall program efficacy of 81.2%, establishes a more effective clinical loop than alternative strategies prioritizing participation over the technical reliability required to meet the 0

    “The successful identification and clinical management of 723 individuals with precancerous cervical lesions informs that the integration of high-quality diagnostic triaging with immediate intervention (Figure 3), yielding an overall program efficacy of 81.2%, establishes a more effective clinical loop than alternative strategies prioritizing participation over the technical reliability required to”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reference categories for each variable were selected based on convenience, following an order from highest to lowest prevalence values to establish a baseline for comparative analysis.

    “Reference categories for each variable were selected based on convenience, following an order from highest to lowest prevalence values to establish a baseline for comparative analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    By adhering to criteria of Meijer et al and the VALGENT framework, the study ensured that molecular testing provided superior NPV, offering long-term reassurance necessary to safely extend screening intervals to the WHO-recommended twice-per-life time strategy.

    “By adhering to criteria of Meijer et al and VALGENT11,12 framework, the study ensured that the molecular testing provided superior NPV, offering the long-term reassurance necessary to safely extend screening intervals to the WHO-recommended twice-per-life time strategy.8”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Meijer et al

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites VALGENT11,12

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    Achieving WHO 2030 targets necessitates state-specific policies and digital health integration to bridge systemic linkage-to-care gaps.

    “This large-scale evaluation confirms the technical feasibility of decentralized screening in resource-limited settings and demonstrates that achieving WHO 2030 targets necessitates state-specific policies and digital health integration to bridge systemic linkage-to-care gaps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Our findings demonstrate that decentralized see-and-treat models are technically feasible and accurate.

    “Our findings provide a scalable roadmap for cervical cancer elimination by demonstrating that decentralized “see-and-treat” models are technically feasible and accurate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Opportunistic hrHPV DNA-based screening using a decentralized see-and-treat model is clinically robust, achieving high diagnostic accuracy (AUC 0.95) with high sensitivity (0.98).

    “Opportunistic hrHPV DNA-based screening using decentralized “see-and-treat” model is clinically robust, achieving high diagnostic accuracy (AUC 0.95) with high sensitivity (0.98).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The use of convenience sampling may underrepresent the burden in underserved or rural areas.

    “Key limitations include the use of convenience sampling, which may underrepresent the burden in underserved or rural areas.”
    Quote in the paperNot a substantial claim
48 of 48

  • The paper relies on this without support.

    Large-scale evidence on implementation of decentralized treatment pathways for HPV screening in India is limited.

    “large-scale evidence on implementation via decentralized treatment pathways in India is limited.”

  • The paper relies on this without support.

    In the absence of structured national programs, opportunistic screening integrated into public health initiatives offers a replicable model for early detection.

    “In the absence of structured national programs, opportunistic screening integrated into public health initiatives offers a replicable model for early detection.”

  • The paper relies on this without support.

    Previous research by the authors identified disproportionately high hrHPV positivity in cohorts with known HIV, commercial sex work, or incarceration.

    “This decision was informed by our previous research identifying disproportionately high hrHPV positivity in these cohorts, which necessitates specialized clinical management outside the scope of general community screening.”

  • The paper relies on this without support.

    Colposcopy and histopathology are valid reference standards for diagnosing cervical lesions.

    “The performance of the see-and-treat modality was assessed through Pearson correlation between colposcopy and histopathology, and area under the curve (AUC) with sensitivity and specificity metrics.”

  • The paper relies on this without support.

    The community-based sub-cohort is representative of the broader population of HPV-positive women in similar resource-limited settings.

    “The primary cohort (including community and hospital recruitment) consisted of 5,354 hrHPV-positive individuals (8.5% positivity), further categorized into a community-based sub-cohort (3,813) to assess the diagnostic and positive predictive value (PPV) of the decentralized “see-and-treat” modality with the community.”

  • The paper relies on this without support.

    The see-and-treat modality can be adequately assessed by Pearson correlation and AUC.

    “The performance of the see-and-treat modality was assessed through Pearson correlation between colposcopy and histopathology, and area under the curve (AUC) with sensitivity and specificity metrics.”

  • The paper relies on this without support.

    The shortfall from the WHO 90% management mandate is due to real-world socio-logistical determinants including domestic responsibilities and geographical accessibility.

    “This shortfall from the WHO 90% management mandate is not a failure of decentralized modality but a result of real-world socio-logistical determinants, including domestic responsibilities and geographical accessibility.”
7 of 7

Cites

Flagged first, then by citations

Authors
Rao, S., Chhabra, M., Kudkuli, J., Toraskar, M., Nath, A. G., Prakash, D., Srivastava, S., Imo Singh, W., Chandrasekharan, M., Oswal, K., Randhawa, J., & Ramachandran, V.
Corresponding author
Chhabra, Mayank
ORCID
Venue
AJOG Global Reports
Publisher
Elsevier BV
Published
2026-08
Volume
6
Issue
3
Pages
100678
ISSN
2666-5778 (ISSN-L)
DOI
10.1016/j.xagr.2026.100678
PMC
PMC13524459
OpenAlex
W7171692086
Semantic Scholar
ef03d2e0d71c03b44f2d93ceb3be77527cd2f076
Cited by
0
References
21
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • AJOG Global Reports (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
cervical cancer screening, HPV testing, high-risk HPV, decentralized treatment, thermal ablation, LLETZ, HPV genotype distribution, self-collected samples, medication adherence, overtreatment and undertreatment, community-based screening, India, diagnostic accuracy, cervical intraepithelial neoplasia, colposcopy triage

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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