The research, led by Susanta Kumar Swain of the Odisha Department of Health and Family Welfare together with colleagues from the Acharya Harihar Post Graduate Institute of Cancer, the Indian Council of Medical Research, and the Norway India Partnership Initiative, set out to test whether a home-based screening model could be delivered through the existing public health system rather than through parallel, donor-driven structures. The team implemented what is known as a screen–triage–treat approach in Thoria Sahi, a settlement in Cuttack, targeting women between the ages of 30 and 65. Data collected between October 2022 and September 2023 were analyzed to measure screening coverage, HPV positivity, follow-up behavior, and treatment outcomes.

The technical logic of the model rests on the biology of the disease itself. Virtually all cases of cervical cancer are caused by persistent infection with high-risk types of human papillomavirus, and detecting the virus’s DNA in cervical cells is a more sensitive screening method than conventional cytology. Crucially, self-collected vaginal samples have been shown in multiple international studies to perform nearly as well as clinician-collected specimens for HPV testing. That property makes self-sampling a powerful tool for communities where cultural norms, modesty concerns, time constraints, and distrust of pelvic examinations keep women away from clinics. In Thoria Sahi, the program leaned on Accredited Social Health Activists, or ASHAs, the frontline community health workers who form the backbone of India’s rural and urban health outreach, to mobilize eligible women and support them in collecting samples at home.

The numbers from the pilot are striking. Of 6,436 women identified as eligible, 4,896 completed screening, a coverage rate of 76 percent. Among those screened, 322 women, or 7 percent, tested positive for high-risk HPV, a prevalence consistent with expectations for a population that had never previously been screened. Each positive result triggered a referral to an Urban Primary Health Centre, where nurses trained in visual inspection with acetic acid, or VIA, performed triage. This two-step design reflects current World Health Organization guidance, which favors HPV-based primary screening followed by a same-day triage test so that women with likely precancerous lesions can be treated immediately rather than lost to follow-up.

Here the pilot encountered the challenge that has undermined many screening programs before it: the follow-up gap. Despite counselling, only 42 percent of HPV-positive women, 135 of 322, returned to a health centre for VIA triage. Of those who did, 38.5 percent were VIA-positive, indicating likely precancerous changes. Among VIA-positive women, 81 percent received thermal ablation on the spot, a low-cost outpatient procedure that uses a heated probe to destroy abnormal cervical tissue. The remainder were referred for colposcopy, biopsy, and further management in line with national guidelines. In total, the program identified and appropriately managed seven cases of precancerous lesions and one case of micro-invasive carcinoma, detections that in an unscreened population would likely have surfaced only years later as advanced, difficult-to-treat disease.

The authors are candid about what the attrition at the triage stage means. A screening program is only as strong as its weakest link, and the drop from 322 HPV-positive women to 135 who completed triage illustrates that testing alone does not guarantee protection. Community-based follow-up by ASHAs confirmed that women who did receive treatment adhered to it and remained well, which suggests the treatment pathway itself functioned smoothly once patients entered it. The bottleneck lay in getting women from a positive home test to the clinic door, a gap shaped by fear, stigma, household obligations, and the practical costs of travel and waiting time. The study’s central lesson, as the authors put it, is that referral and treatment systems must be strengthened from the outset, not retrofitted after a screening campaign has generated a backlog of positive results.

Why does this matter on a global scale? The World Health Organization has set an ambitious goal of eliminating cervical cancer as a public health problem, a target that requires 70 percent of women to be screened with a high-performance test at least twice in their lives by 2030. India, with its enormous population and historically low screening uptake, is pivotal to that effort. National Family Health Survey 5 data showing screening coverage below 2 percent underline how far the country is from the target, and conventional clinic-based approaches have repeatedly failed to close the gap. Self-sampling flips the equation by removing the most intimidating step, the pelvic examination, and by bringing the test to women rather than requiring women to come to the test.

The Odisha pilot is also notable for what it did not do: it did not build a parallel health system. The model was embedded in the public health infrastructure, using government ASHAs for mobilization and follow-up, Urban Primary Health Centres for triage, and designated treatment centres for colposcopy and surgical management. That integration matters for scalability, because vertical programs funded by short-term grants often collapse when the funding ends. By demonstrating that a screen–triage–treat cascade can run through existing public machinery, the study offers a template that state health departments could adapt, provided they invest in supply chains for HPV test kits, laboratory capacity for DNA testing, and training for frontline workers.

The technical details of the cascade deserve attention for anyone designing similar programs. HPV-DNA testing detects the genetic material of high-risk virus types, identifying women at risk before any cellular abnormality appears, which gives clinicians a longer window for intervention than cytology-based screening. VIA, the triage step used here, involves applying dilute acetic acid to the cervix and looking for acetowhite areas that suggest precancerous change; it is inexpensive, requires minimal equipment, and allows immediate see-and-treat decisions. Thermal ablation is appropriate for lesions that meet size and location criteria and is far simpler than excisional procedures, making it feasible at primary care level. The 38.5 percent VIA positivity among HPV-positive women in this pilot is within the range reported in comparable Indian studies, reflecting the fact that most HPV infections clear spontaneously and only a minority progress to lesions.

The study received no external funding and was approved by the State Research and Ethical Committee of the Odisha Department of Health and Family Welfare, with written informed consent obtained from all participants. Its findings arrive at a moment when HPV vaccination is expanding and molecular diagnostics are becoming cheaper, creating a rare window in which elimination of cervical cancer in low-resource settings looks technically achievable. The Odisha experience shows that when the test comes to the woman, coverage can soar; the unfinished work lies in ensuring that a positive result is followed swiftly by triage and treatment. If health systems can close that loop, home-based self-sampling could become one of the most consequential public health tools of the decade, turning a disease that kills quietly into one that is caught early, treated cheaply, and ultimately prevented.

Subject of Research: Home-based HPV-DNA self-sampling for cervical cancer screening in underserved urban communities in India

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

Article References: Swain, S. K., Nayak, B., Hariprasad, R., Rattan, R., Srivastava, A. K., Bhargava, S., & Biswal, D. K. (2026). Improving coverage of cervical cancer screening for hard-to-reach women: lessons learned from piloting an innovative home-based screening model in Odisha, India. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15839-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15839-7

Keywords: cervical cancer, HPV-DNA testing, self-sampling, cancer screening, Odisha, India, ASHA health workers, screen-triage-treat, thermal ablation, VIA, public health, urban slums

The study team, led by researchers from Dr. Ram Manohar Lohia Institute of Medical Sciences in Lucknow, the global health organization Jhpiego, and the Kalyan Singh Super Speciality Cancer Institute, designed the intervention to answer a pragmatic question: can WHO-recommended HPV DNA screening actually function within the existing machinery of a rural Indian district, rather than in a purpose-built research clinic? To find out, they leveraged the government’s own assets—its network of Health and Wellness Centres, its digital health platforms, and, crucially, its cadre of Accredited Social Health Activists, or ASHAs, the community health workers who serve as the connective tissue between villages and the formal health system. Women aged 30 to 65 years were identified as the eligible screening population, reflecting the age band in which cervical cancer risk is most concentrated and in which screening yields the greatest benefit.

The scale of the mobilization effort was considerable. Of 23,972 eligible women identified across the district, 10,141 ultimately underwent HPV DNA testing, corresponding to a screening uptake of 42 percent. That figure takes on greater significance when set against the baseline: in the intervention areas, screening coverage had previously stood at a mere 1.5 percent. By the end of the project period, coverage had climbed to more than 45 percent, a roughly thirtyfold increase achieved without constructing new facilities or importing an entirely parallel health delivery structure. The engine of this transformation, according to the study, was the offer of choice in how samples were collected. Women could either collect their own vaginal samples—a method that requires no pelvic examination and can be performed in the privacy of the home—or have a sample collected by a provider at a Health and Wellness Centre. The preference was striking: 83 percent of screened women opted for self-sampling, underscoring how profoundly the logistics of sample collection shape participation in screening programs.

The technical architecture of the testing pipeline is where the study makes some of its most useful contributions. Rather than committing to a single technology, the project deliberately evaluated two complementary platforms. High-throughput centralized laboratories could process large volumes of samples with the efficiency and quality control that molecular diagnostics at scale demand, while low-throughput near point-of-care devices brought testing closer to the communities where women live, shortening the distance between sample collection and result. HPV positivity across the different technology platforms fell within a narrow band of 3.3 to 4.7 percent, a consistency that matters enormously for program planners. It suggests that the choice of platform need not fundamentally alter the epidemiological picture a screening program generates, giving districts flexibility to match testing technology to local infrastructure, sample volumes, and supply chains rather than forcing a one-size-fits-all solution.

Genotype analysis added another layer of programmatic intelligence. HPV-16 emerged as the most prevalent high-risk genotype, accounting for 31 percent of positive results. This finding aligns with global patterns, in which HPV-16 and HPV-18 together drive the majority of cervical cancer cases, and it carries implications for both vaccination policy and the design of partial-genotyping assays that can flag infections caused by the most oncogenic virus types for more urgent clinical attention. In a screening program, knowing the local genotype distribution helps calibrate triage protocols and informs expectations about how many women will need follow-up procedures after a positive screen.

A positive HPV test is not a diagnosis of cancer; it is a signal that requires triage to distinguish transient infections from lesions that warrant treatment. The Amethi project operationalized this critical second step using Visual Inspection with Acetic Acid, or VIA, a low-cost technique in which diluted acetic acid is applied to the cervix and precancerous tissue temporarily turns white, making it visible to a trained provider. Women whose triage confirmed treatable lesions could receive thermal ablation—a method that destroys abnormal tissue using a heated probe—at sub-district facilities, keeping care close to home. Those requiring more advanced procedures, such as loop electrosurgical excision procedure, or LEEP, were referred upward through the system. The decentralized model worked: 52 percent of screen-positive women received thermal ablation locally, and notably, this proportion held steady regardless of whether a woman’s screening sample had been processed on the high-throughput centralized platform or the low-throughput near point-of-care device. The equivalence across platforms suggests that the hybrid testing model did not create inequities in downstream care.

The study is candid about its most persistent challenge: loss to follow-up. Women who screened positive but felt entirely well—because HPV infections and their precancerous consequences are asymptomatic in their early, most treatable stages—were the group most likely to drop out of the care cascade. This is a well-documented vulnerability of all screening programs, but it is especially acute where the screened condition is silent and where returning to a facility carries costs in time, travel, and wages. The authors point to the program’s digital dashboards, which enabled real-time monitoring of screening and treatment indicators, as a tool for identifying where women were falling through the cracks. Such data systems, the study suggests, are not administrative luxuries but core components of a screening program’s clinical effectiveness, allowing supervisors to target follow-up efforts precisely where the cascade is leaking.

Ethical oversight for the project was provided by the Institutional Ethics Committee of Dr. Ram Manohar Lohia Institute of Medical Sciences, with an additional Non-Research Determination from Johns Hopkins University, and procedures were conducted in accordance with the Declaration of Helsinki. Women undergoing HPV screening gave verbal consent, while participants enrolled in interviews examining loss to follow-up provided written informed consent. The work was partially supported by Roche Diagnostics, which reviewed the manuscript but, according to the authors, had no role in study design, data collection, data analysis, interpretation of findings, or the decision to submit the manuscript for publication. The authors declare no competing interests.

The significance of the Amethi project extends well beyond a single district in Uttar Pradesh. India carries a disproportionate share of the global cervical cancer burden, and the WHO’s global strategy to eliminate cervical cancer as a public health problem depends heavily on whether large, high-burden countries can achieve high screening coverage. The conventional obstacles are well known: cytology-based screening requires laboratory infrastructure and repeated visits that many women cannot manage; visual inspection methods, while cheap, are operator-dependent and less sensitive. HPV DNA testing breaks this trade-off by offering high sensitivity with a single visit for sample collection, and self-sampling removes the most intimate barrier of all. What the Amethi study adds is proof that this combination can run on government rails—ASHA mobilization, Health and Wellness Centres, district laboratories, and digital monitoring—rather than requiring a parallel donor-funded system that would be impossible to sustain.

The authors frame their conclusions around feasibility, acceptability, and programmatic relevance, and each is supported by concrete numbers: a thirtyfold rise in coverage, an 83 percent preference for self-sampling, consistent HPV positivity across platforms, and half of screen-positive women treated locally. The remaining work is equally concrete—closing the follow-up gap for asymptomatic screen-positive women, and translating a district demonstration into state and national policy. For program designers across India and in other low-resource settings, the study offers a woman-centered, data-driven template: mobilize trusted community health workers, let women choose self-collection, run a hybrid of centralized and point-of-care testing matched to local capacity, triage and treat as close to home as safely possible, and monitor every step in real time. If the lessons of Amethi travel, the study may come to be seen as an early milestone in India’s path toward cervical cancer elimination.

Subject of Research: Implementation of HPV DNA test-based cervical cancer screening with self-sampling in rural Indian public health settings

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

Article References: Husain, N., Bhamare, P., Qureshi, S., Kaur, N., Nawaz, A. S., Hegde, S. K. B., Singh, D., Tripathi, S., & Kumar, S. (2026). Facilitating HPV DNA test-based screening for cervical cancer in public health settings of India: learnings from the Amethi project. BMC Public Health. https://doi.org/10.1186/s12889-026-29409-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29409-3

Keywords: cervical cancer, HPV DNA testing, self-sampling, screening coverage, India, Uttar Pradesh, ASHA health workers, point-of-care testing, thermal ablation, VIA triage, HPV-16, public health