Supply-Side Barriers in Accessing Human Papillomavirus Screening for Cervical Cancer Prevention in Rural India: Evidence From a Cross-Sectional Study.

BACKGROUND

Cervical cancer is a leading cause of cancer-related mortality among women worldwide, particularly in low- and middle-income countries. In India, rural areas face a disproportionate burden of cervical cancer cases. Effective screening methods, such as Human Papillomavirus (HPV) testing, are recommended by the World Health Organization (WHO) for early detection and prevention. However, the uptake of these screening methods in rural India is significantly low due to various supply-side barriers. This study aims to evaluate the readiness and capacity of PHCs in rural India to conduct HPV screening tests.

MATERIALS AND METHODS

This cross-sectional study in Pondicherry, India, examined cervical cancer screening and management at 15 primary health centers (PHCs) through a structured questionnaire. It assessed personnel training for HPV screening, availability of screening tests, healthcare infrastructure functionality, supply chain efficiency, infection prevention practices, medicine and diagnostic supply availability, referral protocols, data management practices, policy adherence, and equipment availability.

RESULTS

Visual inspection with acetic acid was available in all PHCs, while more advanced tests like cytology, HPV testing, loop electrosurgical excision procedure (LEEP), colposcopy, and histology/pathology were generally absent. Only one PHC had personnel trained for cytology processing, with none trained for other advanced procedures or HPV testing. The study identified significant gaps in healthcare infrastructure, trained personnel, and supply chain logistics.

CONCLUSION

Enhancing cervical cancer screening and treatment in PHCs necessitates investments in infrastructure, training, and data systems. Key priorities include upgrading equipment like colposcopes and implementing a robust Health Management Information System (HMIS). Collaboration with stakeholders is essential for effective resource allocation and capacity building.