Facilitating HPV DNA test-based screening for cervical cancer in public health settings of India: learnings from the Amethi project

Cervical cancer remains a leading cause of morbidity and mortality among women in India, with low screening coverage posing a significant challenge. While HPV DNA testing is the WHO-recommended modality for cervical cancer screening, its integration within India’s public health system, especially in rural settings, remains limited. This intervention aimed to assess the feasibility of implementing HPV DNA testing through self-sampling and to explore the differential value of centralized high-throughput and near Point-of-Care (PoC) low-throughput testing platforms within routine health public services. This was a district-level programmatic implementation study conducted in Amethi district, Uttar Pradesh, leveraging the government’s existing health infrastructure, digital platforms, and frontline health workers. Women aged 30–65 years were mobilized through ASHAs and offered screening via self-sampling or provider-led collection at Health and Wellness Centres (HWCs). Samples were processed using high throughput centralized and low throughput near point of care platforms. Screen-positive women underwent triage using Visual Inspection with Acetic Acid (VIA) and were managed through thermal ablation at sub-district facilities or referral for advanced procedures like LEEP. Of 23,972 eligible women identified, 10,141 (42%) were screened using HPV DNA testing, with 83% opting for self-sampling. Screening coverage in intervention areas improved from 1.5% to over 45%. HPV positivity was in the range of 3.3% to 4.7% on different technology platforms, with HPV-16 being the most prevalent genotype (31%). Decentralized triage and treatment were operationalized effectively across platforms, with 52% of screen-positive women receiving thermal ablation locally, regardless of whether screening used high-throughput laboratory-based or low-throughput near-point-of-care HPV DNA testing Loss to follow-up remained a concern, driven largely by asymptomatic presentation. Program dashboards facilitated real-time monitoring of screening and treatment indicators. The intervention demonstrates the feasibility, acceptability, and programmatic relevance of HPV DNA testing through a self-sampling strategy and hybrid testing model within India’s public health system. Findings offer actionable insights for scaling cervical cancer screening programs with a woman-centered, context specific and data-driven approaches.