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40 Training paramedical staff to perform cervical cancer screening with aid of specially designed video based tutorials and comparative evaluation of HPV versus cytology as triage test among via positive women
  1. Gauravi Mishra1,
  2. T Shylasree1,
  3. Santosh Noronha2,
  4. Pramesh Cs1,
  5. Sharmila Pimple1,
  6. Vasundhara Kulkarni1 and
  7. Heena Shaikh1
  1. 1Tata Memorial Hospital
  2. 2Indian Institute of Technology


Introduction/Background Visual Inspection after application of 5% acetic acid (VIA) has been recommended for primary cervical cancer screening in India. The objectives were to develop and validate video based training tool for capacity building of paramedical staff in cancer awareness and screening, thereby reducing expert time requirement and duration of training and to comparatively evaluate performance of HPV Hybrid Capture 2 (HC2) and Cytology as triage tests among VIA screen positive women, thus aiming to reduce referral burden.

Methodology Video based tutorials were prepared in 14 modules. These videos included conducting cancer awareness, performing VIA, collecting samples for HPV and Cytology. The paramedical staff were invited for training. The standard training of 12 weeks was reduced to two weeks using new tool. Practical demonstration and micro-teaching was combined with tutorials training on pre-loaded tablets.

Community based cervical cancer screening with VIA was conducted among women aged 30–65, residing in Mumbai, India, by trained Primary Health Workers (PHWs). After obtaining informed consent, delivering cancer awareness, participants were offered VIA screening by trained PHWs. All VIA screen positive women underwent Cytology and HPV HC2 and later diagnostic Colposcopy at nodal hospital. Women with positive Colposcopy underwent cervical biopsies.

Results Fifty trainees were evaluated with theory and practical evaluation. All trainees found training to be informative, easy to understand and felt confident to deliver cancer awareness, perform VIA and collect samples for HPV and Cytology.

231 VIA positive women underwent Cytology and HPV HC2 test, followed by Colposcopy. Cervical biopsies were obtained in 83 cases. The sensitivity and specificity in detecting ≥ CIN 2 were 77.8 and 92.3 for HC2 and 66.7 and 98.2 for cytology. The false positivity and negativity rates were 7.7 and 22.2 for HC2 and 1.8 and 33.3 for cytology.

Conclusion With India now being on roll out mode of cancer control programme, it’s outcome will depend on quality of training that will be imparted to health services staff. The preparation and validation of these indigenously prepared video based tutorials has opened new avenue by which vast majority of paramedical staff could be trained in relatively shorter duration and utilizing least expert time.

The study shows that paramedical staff can be trained to collect HPV samples and that HPV HC2 reduces referrals to larger extent and misses fewer cases compared to cytology, thus appearing a better triage test among VIA positive women.

Disclosures TMH-IIT Collaborative projects through Tata Trusts and DAE Grants

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