Improving coverage of cervical cancer screening for hard-to-reach women: lessons learned from piloting an innovative home-based screening model in Odisha, India

Cervical cancer is the second most common cancer among women in India, with mortality largely attributed to late-stage diagnosis and low screening coverage. Despite national efforts, screening uptake remains under 2% as reported in National Family Health Survey 5. This study assessed the feasibility and acceptability of a home-based HPV-DNA self-sampling model piloted in an underserved urban slum in Odisha, India. The screen–triage–treat model was implemented through the public health system in Thoria Sahi, Cuttack, targeting women aged 30–65 years. Accredited Social Health Activists (ASHAs) mobilized eligible women for home-based HPV-DNA self-sample collection. Women who tested positive were referred to Urban Primary Health Centres (UPHCs) for VIA-based triage. Those eligible received immediate thermal ablation, while others were referred for colposcopy, biopsy, and further management as per national guidelines at designated treatment centres. Data from October 2022 to September 2023 were analyzed to assess screening coverage, HPV positivity, follow-up, and treatment outcomes. Of 6,436 eligible women, 4,896 (76%) were screened. Among them, 322 (7%) tested positive for high-risk HPV. Despite counselling, only 42% (135/322) of HPV-positive women underwent VIA triage at UPHCs and of them 38.5% were found VIA-positive. Among VIA-positive women, 81% received thermal ablation, while the remainder were referred for colposcopy and biopsy and further management. Seven cases with pre-cancerous lesions and one case of micro-invasive carcinoma were diagnosed and managed appropriately. Community-based follow-up by ASHAs confirmed treatment adherence and well-being. Home-based HPV-DNA self-sampling integrated with existing public health infrastructure is a feasible and acceptable strategy to improve cervical cancer screening in low-resource urban settings. The model demonstrated strong community uptake and early lesion detection. Strengthening referral and treatment systems from the outset will be critical to achieving broader impact and scale.