Challenges in setting up a primary human papillomavirus-DNA testing facility in a lower and middle income country: lessons learned from a pilot programme
Open accessAbstract
Introduction: Detection of high-risk human papillomavirus (hrHPV) is the most sensitive test for the screening of cervical cancer. Although most high-income countries have adopted this strategy in their screening programme, there are a lot of barriers in low and middle-income countries (LMICs) in setting up this facility for screening. The lessons learned based on this experience can be useful for other LMICs in their first steps to integrate HPV testing into a screening programme. Methods: HPV testing using self-sampling was offered to eligible women residing in one district of Sikkim state. To implement the same, a testing laboratory was set up in the district and the challenges faced are listed. Results: The cost of testing equipment, sampler and cold storage was beyond the budget capping. Setting up of the HPV testing lab accessible to study sites and referral centre was a difficult decision to make. Training the health care providers in their proficiency in triaging and treatment was challenging. Coordinating with community health workers and beneficiaries for effective screening and establishing referral linkages was not easy, as we expected. The cost of transportation, consumables and contingencies was higher due to the difficult terrain. Conclusion: The cost of the equipment and consumables for primary HPV screening can be reduced in bulk purchases through negotiations. Adequate knowledge of the terrain and economic implications of the area of interest is crucial during the budgeting of the programme. Collaborating with the state government, integration with the existing health system and repurposing the available resources are key for success. The barriers faced during implementation are stepping stones for improvement.
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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”
From 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 (2026) · cites this paper as [26]
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 measuredOur 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”
From 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 (2026) · cites this paper as [26]
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)
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- Authors
- Dhanasekaran, K., Tamang, T., Pradhan, S., Lhamu, R., & Hariprasad, R.
- Affiliations
- Indian Council of Medical Research (IN)
- Government of Sikkim (IN)
- Venue
- ecancermedicalscience
- Publisher
- Ecancer Global Foundation
- Published
- 2022-12-19
- Volume
- 16
- Pages
- 1492-1492
- ISSN
- 1754-6605 (ISSN-L)
- PMC
- PMC9935055
- OpenAlex
- W4313408296
- Cited by
- 11
- References
- 12
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 6 · 2023: 1
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- ecancermedicalscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Indian Council of Medical Research
- 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
- HPV testing, cervical cancer screening, primary HPV testing, self-sampling, low- and middle-income countries, screening program implementation, health system integration, community health workers, referral linkages, cost barriers, Sikkim
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