Asking clinicians how best to reduce the cervical cancer burden in India - a qualitative study from Mysore

Authors: Herbst de Cortina, S., Pramathesh, R., Jayakrishna, P,, Srinivas, V., Madhivanan, P., Adsul, P.

Category: Global Cancer Research
Conference Year: 2020

Abstract Body:
Cervical cancer is the second most common cancer among Indian women, but HPV vaccination and screening rates remain low. India is rolling out a national cervical cancer prevention strategy including using Visual Assessment with Acetic acid (VIA) in resource-limited settings. We interviewed clinical providers in Mysore, India to understand their perspectives on cervical cancer prevention and strategies for implementation in their communities. Between November 2015 and January 2016, physicians participated in one-on-one in depth interviews conducted in English using a semi- structured guide. A total of 30 physicians were interviewed, 15 (50%) primary care physicians, 7 (23.3%) gynecologists, 6 (20%) oncologists, and 2 (6.7%) pathologists. Approximately two-thirds (n=19, 63.3%) worked in the public sector and one-third (n=11, 36.7%) in the private sector. A minority of clinicians mentioned HPV vaccination as an important strategy for cancer prevention but highlighted cost as a barrier and the need for incorporation of HPV into national vaccination programs. Only 7 (23.3%) of physicians were currently providing cervical cancer screening, and none of the primary care physicians reported screening patients. Less than half of physicians (n=14, 46.7%) were aware of VIA. Most providers working in Primary Health Care settings reported that a VIA-based screening program would be acceptable in their settings and appropriate for the communities they serve. However, almost all mentioned the need for training and that their high workload limited their ability to incorporate new programs. Findings from this study highlight the need for targeted interventions that build provider knowledge, skills, and capacity to implement cervical cancer prevention for women in Mysore.

Keywords: cervical cancer, India, cancer prevention