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Cited by 20Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

Challenges in the Implementation of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in India: A Systematic Review

Open access
Hariprasad, Roopa, John, Amrita, Abdulkader, Rizwan Suliankatchi·2023·JCO Global Oncology
DOI 10.1200/go.22.00401PMC PMC10281403
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Abstract

PURPOSE: In the light of WHO's call for elimination of cervical cancer, primary human papillomavirus (HPV) screening through self-collection is a powerful tool that can improve screening coverage. Challenges encountered during implementation of the program are unique to each country. We conducted this systematic review to list the challenges in implementing primary HPV screening through self-sampling in Indian context. METHODS: A literature search was performed in PubMed, Embase, and Google Scholar since their inception till July 2022 for peer-reviewed articles published in the English. Non-Indian studies and those which did not mention implementation challenges were excluded. Articles were screened and reviewed independently by two authors. The results were discussed using a narrative synthesis. RESULTS: All the eight original articles included in the review were of cross-sectional design. The challenges identified in these studies were grouped into beneficiary, health care provider, and health system perspectives. Beneficiary-related issues outnumbered other challenges in all the studies which included misconceptions and fear, lack of motivation, low self-efficacy in collection leading to poor sample quality, low socioeconomic status leading to lack of privacy, and refusal for screening and further treatment. CONCLUSION: This review highlights the challenges for the implementation of HPV self-sampling in India. Future programs should incorporate context-specific solutions for the success of primary HPV screening and cervical cancer elimination.

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  • There are no randomised controlled trials that have compared implementation outcomes of programme approaches for self-collection.

    “Although multiple studies have offered self-collection for human papillomavirus (HPV)-based cervical screening in community settings, there are no randomised controlled trials (RCTs) that have compared implementation outcomes of programme approaches for self-collection.”

    From Protocol for a cervical screening implementation trial comparing two approaches for delivering HPV self-collection in low-resource settings in India: a type 3 hybrid cluster randomised controlled trial (SHE-CAN) (2025) · cites this paper as [14]

    The Results report that all eight included studies were cross-sectional, supporting the absence of RCTs among the Indian implementation studies this review examined. The Methods limit the review to Indian studies reporting implementation challenges, so it cannot establish the claim that no RCTs anywhere have compared implementation outcomes of programme approaches to self-collection. The Introduction also reports RCTs comparing self-sampling with standard screening, although that is not the same programme-approach comparison. (LLM, conf=0.85)

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Research works printed but not linked: 25

  1. [4]Arbyn M Verdoodt F Snijders PJF et al Accuracy of human papillomavirus testing on self-collected versus clinician-collected samples: A meta-analysis Lancet Oncol 15 172 183 2014 24433684
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  7. [11]Kamath Mulki A Withers M Human papilloma virus self-sampling performance in low- and middle-income countries BMC Women's Health 21 12 2021 33407355 PMC7789658
  8. [12]Hariprasad R John A Rizwan SA Challenges in the implementation of Human Papilloma Virus self-sampling for cervical cancer screening in India; A systematic review. PROSPERO 2022CRD42022338241 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338241 PMC10281403 36989463
  9. [14]Basu P Mahajan M Patira N et al A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India BMC Public Health 19 14 2019 30606132 PMC6318877
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  11. [16]Sowjanya AP Paul P Vedantham H et al Suitability of self-collected vaginal samples for cervical cancer screening in periurban villages in Andhra Pradesh, India Cancer Epidemiol Biomarkers Prev 18 1373 1378 2009 19423518 PMC2762740
  12. [17]Bansil P Wittet S Lim JL et al Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: A mixed methods approach BMC Public Health 14 596 2014 24927941 PMC4061776
  13. [18]Poli UR Muwonge R Bhoopal T et al Feasibility, acceptability, and efficacy of a community health worker-driven approach to screen hard-to-reach peri urban women using self-sampled HPV detection test in India JCO Glob Oncol 6 658 666 2020 32343627 PMC7193819
  14. [20]Penaranda E Molokwu J Flores S et al Women's attitudes toward cervicovaginal self-sampling for high-risk HPV infection on the US-Mexico border J Low Genit Tract Dis 19 323 328 2015 26360234 PMC4583792
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  18. [24]Hariprasad R Tulsyan S Babu R et al Evaluation of a chip-based, point-of-care, portable, real-time micro PCR analyzer for the detection of high-risk human papillomavirus in uterine cervix in India JCO Glob Oncol 6 1147 1154 2020 32697666 PMC7392761
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Cited by

Sorted by citations

Authors
Hariprasad, R., John, A., & Abdulkader, R. S.
Affiliations
  • Indian Council of Medical Research (IN)
  • Charité – Universitätsmedizin Berlin (DE)
  • National Institute of Epidemiology (IN)
Corresponding author
Abdulkader, Rizwan Suliankatchi
ORCID
Venue
JCO Global Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2023-03
Volume
9
Issue
9
Pages
e2200401-e2200401
ISSN
2687-8941 (ISSN-L)
DOI
10.1200/go.22.00401
PMC
PMC10281403
OpenAlex
W4361301970
Cited by
20
References
4
Citations by year
2026: 2 · 2025: 10 · 2024: 7 · 2023: 1
FWCI
0.78
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JCO Global Oncology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
human papillomavirus, HPV self-sampling, cervical cancer screening, primary HPV testing, cervical cancer elimination, India, self-efficacy, socioeconomic barriers, screening refusal, health system barriers
MeSH terms
Human Papillomavirus Viruses, Uterine Cervical Neoplasms, Cross-Sectional Studies, Female, Humans, Papillomavirus Infections, Early Detection of Cancer

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