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

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.

The acceptability of, and informational needs related to, self‐collection cervical screening among women of Indian descent living in Victoria, Australia: A qualitative study

“…43 A systematic review in India exploring the implementation of self-collection found patient-level barriers, including lack of knowledge and misconceptions, low prioritisation to screen and poor sample quality due to a lack of self-efficacy outweighed provider-and systems-level barriers. 44 Solutions to address patient-level barriers centred around community engagement and education strategies, including access to self-collection swabs for women to develop familiarisation with the test and to mitigate fears and misconceptions related to self-collection. 43 These studies provide contextualisation to our findings on barriers to women's screening participation and views of self-collection in Australia.…”