Cervical Cancer Clinical Trial
Official title:
Acceptability and Validity of Self Sampling for High Risk HPV Detection Among Women in Maharashtra
The study goals are,
1. To determine the test characteristics (sensitivity, specificity, positive predictive
value, negative predictive value, false positivity rates, false negativity rates) of
health personnel collected and self collected HPV samples for Hybrid capture explained
by two different methods (pamphlets/ health education programme).
2. To evaluate the agreement between self collected HPV samples and health personnel
collected HPV samples for Hybrid capture with two different methods of education
(pamphlets/ health education programme).
3. To study the attitudes, acceptability and barriers of self-collection of specimens for
HPV DNA testing in three sub groups of population in Maharashtra with two different
methods of education (pamphlets/ health education programme).
4. To determine the predictors of self-sampling preference.
5. To determine the Knowledge, Attitudes and Practices (KAP) regarding cervical cancer and
HPV infection among these women in pre-intervention and post-intervention period.
The three communities, urban slum area in Mumbai, urban non slum area in Mumbai and rural
area in Raigad/ Thane district will be selected. The eligible women will be contacted by door
to door visit and the purpose of the campaign will be explained to them. Informed consent
will be obtained from those who are willing to participate in the study.
Step 1: They will be interviewed to collect the baseline Knowledge, Attitude and Practices
(KAP) regarding cervical cancer, screening and HPV. The information will be recorded on a
structured questionnaire.
Step 2: Half of the women in each group will be invited to specially organized camps in their
neighborhood for Health Education and distribution of self samplers while the other half will
be provided an information pamphlet on the risk factors, methods of early detection,
prevention, signs and symptoms of cervical cancer and how to use the self samplers at home.
Similar personal interviews, collection of used/unused self sampler and collection of HPV
samples by health worker will be followed for both groups of women.
Intervention one: (Health Education Group) Detailed health education programme explaining
them the risk factors, methods of early detection, prevention, signs and symptoms of cervical
cancer will be conducted. They will be explained the importance of getting screened for
cervical cancer and will be encouraged to undergo screening at any nearby screening centre.
They will be given information regarding HPV self samplers and will be taught the method of
its use and storage in detail. Any queries with this regard will be answered.
Intervention two: (Both Groups) HPV self samplers will be distributed free of cost to the
women and the social workers will instruct them to return it to the clinic or will collect
the samplers from their houses, either on the same day or the following day as per the
convenience of the woman. For HPV self collection the participating women will be asked to
collect the sample specimen as per instructions provided during the health education session/
pamphlets and store it at room temperature till the time of collection by the social worker.
The willingness to use self sampler or refusal to use the HPV self sampler will be captured.
Also, the reasons for their refusal shall be captured.
Step 3: (Both Groups) During the visit by social worker to collect the samples, the women
will be again interviewed by the social worker for their experience about collecting the
sample at home. Personal interviews will be conducted also to assess their acceptability of
self sampling for HPV detection. Various queries regarding difficulties in obtaining, storing
and transporting the samples as well as other potential factors likely to affect the
acceptability of the self sampling methods will be assessed. Any injuries, barriers and
motivators for self sampling will be recorded. The women who refuse to use self samplers at
this stage will also be interviewed to understand the barriers. HPV sample will be collected
by the health worker when the woman comes to return the sampler kit. It will also be
collected for women who refuse self sampling but are ready for health worker collected
sample.
Information about the post-intervention KAP regarding cervical cancer, screening and HPV will
be again recorded on a structured questionnaire from all women.
Step 4: (Both Groups) HPV testing will be performed with the Hybrid Capture System II
{Digene}, which detects 13 different high-risk HPV types {16, 18, 31, 33, 35, 39, 45, 51, 52,
56, 58, 59, 68}. The test will run according to the manufacturer's protocol. HPV
determination will be quantitative, and women with samples producing readings of one or more
times the positive control (1pg/ml HPV DNA) will be considered as HPV test positive.
Step 5: (Both Groups) The reports of self sampling HPV will be distributed to the women after
15 days. The women who test positive on either test will be contacted personally by staff or
by telephone and will be offered free Preventive Oncology check up, Colposcopy and necessary
work up either at Tata Memorial Hospital. The women not willing to avail facility at TMH will
be referred to the nearby municipal or private hospital offering these services.
The women who are positive or negative on colposcopy will undergo further diagnosis and
management as per departmental service protocol. The health worker will co-ordinate between
the field staff and the various departments at TMH. The health worker will submit the samples
to the department of Microbiology at the TMH, will collect the reports and send it to the
field social workers for distribution, will assist the HPV positive patients for further
investigations and diagnosis at the TMH.
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