Developing a scalable, woman-centred model for cervical cancer screening in vulnerable women in India, the SHE-CAN study (Self-collected HPV Evaluation for the Prevention of Cervical CANcer).

In the context of WHO’s callfor the elimination of cervical cancer as a major global health challenge, policy makersare faced with an urgent need for evidence on how to effectively implementcervical screening to achieve population level coverage.

While India’s current policyof Visual Inspection of the cervix with Acetic acid (VIA) is largely based onaffordability, it has suboptimal effectiveness and has never been demonstratedto be scalable to a country level or sustainable, due to the critical need forquality assurance and ongoing training. While researchers in India have advancedrecent global evidence regarding a more effective and scalable approach to cervicalscreening, implementation has not yet occurred at scale.

We will co-design scalable HPVbased cervical screening approaches with stakeholders and others, following an initialassessment of current implementation status of screening, women’s experiences,  health providers’ and community perspectives in vulnerable communities (e.g. tribal, rural and urban poor). Wewill evaluate its implementation through a cluster randomised screening programtrial in rural, urban poor and tribal populations in Tamil Nadu and Mizoram,that have different vulnerable populations, disease profiles and health care settings. Asdemonstrated recently in other low-middle income countries, we aim to demonstratethat a strategy including HPV-based screening is likely to be the most effective,practical, affordable and acceptable method for wide scale adoption by women livingin some of the most underserved areas of India.