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Purpose: Every year > 450,000 individuals are diagnosed with cancer and approximately 350,000 die of it in India. The Ministry of Health and Family Welfare has released an Operational Framework for the Management of Common Cancers that highlights population-based cancer screening programs in primary health care facilities by health care providers (HCPs) and capacity building of HCPs. The purpose of this study is to present a low-cost training model that is highly suitable for resource-deficient settings, such as those found in India, through Extension for Community Health Outcome (ECHO), a knowledge-sharing tool, to enable high-quality training of HCPs. Materials and Methods: An in-person, 3-day training program was conducted for 27 HCPs in the tribal primary health care center of Gumballi in Karnataka, India, to teach the basics of cancer screening in oral, breast, and cervical cancer. The training of HCPs was done using the ECHO platform while they implemented the cancer screening, thus enabling them to build the much needed knowledge and skill set to conduct cancer screening in their respective communities. Results: The knowledge level of the HCPs was tracked before the intervention, immediately after the 3-day training program, and 6 months after the ECHO intervention, which clearly showed progressive acquisition and retention of knowledge. A marked improvement in knowledge level score from an average of 6.3 to 13.7 on a 15-point scale was noticed after the initial in-person training. The average knowledge further increased to a score of 14.4 after 6 months as a result of training using the ECHO platform. Conclusion: ECHO is an affordable and effective model to train HCPs in cancer screening in a resource-constrained setting. [ABSTRACT FROM AUTHOR]

Purpose: Every year > 450,000 individuals are diagnosed with cancer and approximately 350,000 die of it in India. The Ministry of Health and Family Welfare has released an Operational Framework for the Management of Common Cancers that highlights population-based cancer screening programs in primary health care facilities by health care providers (HCPs) and capacity building of HCPs. The purpose of this study is to present a low-cost training model that is highly suitable for resource-deficient settings, such as those found in India, through Extension for Community Health Outcome (ECHO), a knowledge-sharing tool, to enable high-quality training of HCPs. Materials and Methods: An in-person, 3-day training program was conducted for 27 HCPs in the tribal primary health care center of Gumballi in Karnataka, India, to teach the basics of cancer screening in oral, breast, and cervical cancer. The training of HCPs was done using the ECHO platform while they implemented the cancer screening, thus enabling them to build the much needed knowledge and skill set to conduct cancer screening in their respective communities. Results: The knowledge level of the HCPs was tracked before the intervention, immediately after the 3-day training program, and 6 months after the ECHO intervention, which clearly showed progressive acquisition and retention of knowledge. A marked improvement in knowledge level score from an average of 6.3 to 13.7 on a 15-point scale was noticed after the initial in-person training. The average knowledge further increased to a score of 14.4 after 6 months as a result of training using the ECHO platform. Conclusion: ECHO is an affordable and effective model to train HCPs in cancer screening in a resource-constrained setting. [ABSTRACT FROM AUTHOR]

Purpose: To address high breast cancer (BC) mortality globally and especially in low- and middle-income countries (LMICs), resource-stratified screening and treatment guidelines have been provided by global expert groups. How these guidelines are implemented and aligned with facility readiness in low-resource settings is less well understood. We propose to modify, apply, and evaluate a cervical cancer toolkit designed to evaluate facility readiness in LMICs as an implementation science tool for the treatment of BC. Methods: We will draw upon an existing toolkit for cervical cancer, the Improving Data for Decision Making in Global Cervical Cancer Programs (IDCCP) developed by the Centers for Disease Control and Prevention, WHO, and the George W. Bush Institute. The IDCCP includes 13 domains—for example, services, staffing, infrastructure, procurement and supply chain, equipment and supplies, referral pathways, etc—by which to assess facility readiness, and information on six categories is available in India's District Level Household and Facility Level Survey (2012 to 2013). We applied the IDCCP toolkit for cervical cancer screening in India using District Level Household and Facility Level Survey data and propose to extend this work to include BC screening evaluation per Indian government guidelines—clinical breast exam followed by ultrasound, with or without mammography, followed by biopsy as needed across the four tiers of India's public health care system. As a test of construct validation, we will correlate facility readiness for BC screening at the district level with self-reported BC examination data at the district level using the National Family Health Survey-4 (2015 to 2016). Results: Composite scores that summarize the six categories for cervical cancer yield wide variation in facility readiness across 30 states and union territories, with a trend toward higher scores for higher levels of the public health care system. Some consistencies emerge for higher-performing states, such as Maharashtra and Goa. We will conduct similar analyses for BC screening after modifying the tool kit for BC. Conclusion: The modified toolkit for either BC alone or in combination with cervical cancer can be considered an implementation science tool to by which assess facility readiness of health centers in LMICs and for understanding gaps in the implementation of government guidelines. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

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.

Purpose: Currently available human papillomavirus (HPV) detection devices are expensive, requiring a continuous power supply, high-priced reagents, skilled laboratory personnel, and infrastructure. These make it difficult to implement primary HPV screening in high-risk (HR) populations, particularly in low-income settings such as in India. The objective of our study was to evaluate the diagnostic performance of a point-of-care, portable, battery-operated device called Truenat, which detects 4 HR HPV genotypes (16, 18, 31, and 45), as a potentially cost-effective alternative to conventional HPV diagnostic tests., Patients and Methods: This was a single-site, blinded, cross-sectional study that evaluated the performance of the Trunat HPV-HR using cervical samples collected from nonpregnant women > 30 years old via consecutive sampling. The comparison was conducted against the Hybrid Capture 2 (HC2) method. All the positive samples were validated by 14 Real-TM Quant Kit., Results: Of 615 cervical samples, the HR-HPV DNA test was positive in 78 women (12.7%) by HC2 and in 49 (8%) by Truenat. With the consideration of limited genotype inclusivity, the sensitivity and specificity of Truenat HPV-HR were 97.7% and 98.9%, respectively., Conclusion: The performance of Truenat HPV-HR test was comparable to that of HC2 in the 4 HPV genotypes and would be appropriate to consider for use in primary HR cervical cancer screening and particularly in low-income settings.