Integrating a “See-and-Treat” Approach with Opportunistic HPV DNA-based Cervical Cancer Screening in India: A Retrospective Cross-sectional Study

Background India lacks an organized national cervical cancer screening programme, and while WHO recommends HPV DNA testing as the primary modality, large-scale evidence on implementation via decentralised treatment pathways in India is limited. We evaluated the effectiveness of opportunistic hrHPV DNA screening, assessing prevalence, genotype distribution, self-testing acceptance and the diagnostic performance of a community-based “see-and-treat” approach. Objective To evaluate the prevalence and genotype distribution of high-risk human papillomavirus (hrHPV) and assess the diagnostic accuracy, treatment compliance, and clinical viability of a decentralized “see-and-treat” approach within a large-scale opportunistic screening programme across 20 Indian states. Study Design In this retrospective cross-sectional study (Jan 2022–Dec 2025), 62,868 women aged 25-65 years were enrolled across 20 Indian states via community outreach (75·1%) and hospital-based network (24·9%). Screening utilized clinician-collected or self-collected (10·5%) samples tested via the cobas 6800 system. hrHPV-positive women were triaged by colposcopy and managed through a decentralised “see-and-treat” approach using thermal ablation or LLETZ. Primary outcomes included HPV prevalence, diagnostic accuracy (AUC) and treatment compliance. Results Overall HPV prevalence was 8·5% (5,354/62,868), with significant regional variation (11·3% in Delhi NCR to 4·7% in Kerala). Non-16/18 high-risk genotypes accounted for 54·6% of infections. Positivity peaked at ages 26-30 years (10·1%) and a minor peak at 51–55 years (8·4%). The see-and-treat modality demonstrated high diagnostic accuracy (AUC 0·95; sensitivity 0·98; specificity 0·91) with a programme efficacy of 81·2% with 16·3% overtreatment and 21·1% undertreatment. Treatment compliance in the community sub-cohort was 51·3% (1,957/3,813). We identified five women with invasive cancers and 7·8% CIN III (28/357), 9·0% CIN II (32/357) and 26·3% CIN I (94/357) of the histopathology sub-group. Conclusion Opportunistic hrHPV screening integrated with decentralised “see-and-treat” is a clinically robust strategy for LMICs. Significant regional heterogeneity requires tailored, state-specific policies and digital linkage-to-care frameworks to overcome compliance barriers and meet WHO 2030 cervical cancer elimination goals.