Hub & Spoke HPV DNA Screening in Jharkhand: A Cross-Sector Model for Integrating Cervical Cancer Screening Into Primary Health Systems

PURPOSE Despite the availability of effective screening technologies, cervical cancer remains a leading cause of preventable mortality among women in India, particularly in low-resource settings. Jharkhand faces persistent barriers, including low awareness, socio-cultural stigma, limited primary care capacity, and weak referral systems. This study evaluates a district-level pilot implementing a Hub & Spoke model integrating HPV DNA testing within the public health system, with the aim of generating scalable evidence for improving screening uptake and continuity of care. METHODS A 12-month implementation study is ongoing in Dhanbad district through a cross-sector partnership involving the Government of Jharkhand, Cancer Awareness, Prevention and Early Detection (CAPED) Trust, Becton Dickinson (BD), ICMR–National Institute of Cancer Prevention and Research (NICPR), and a tertiary care hospital (Asarfi Hospital). Ayushman Arogya Mandirs function as community-level spokes responsible for awareness generation, counselling, and HPV sample collection, including self-sampling. The tertiary hospital serves as the diagnostic hub for HPV DNA testing and reflex genotyping. Frontline health workers (ASHAs, ANMs, Medical Officers) are trained, and structured patient navigation supports follow-up. Programme evaluation includes baseline and endline assessments of awareness, screening uptake, system readiness, and referral adherence. RESULTS In this ongoing programme, approximately 8,000 women will be screened through a combination of facility-based camps and community-led approaches. So far, the intervention has improved awareness and acceptability of HPV DNA testing, including self-sampling, particularly among underserved populations. Frontline workforce capacity has been strengthened, and coordination between primary facilities and the diagnostic hub has improved sample transport, processing, and reporting. Reflex genotyping enables more efficient triaging, reducing unnecessary referrals and optimising specialist capacity. Patient navigation systems facilitate follow-up for screen-positive individuals, though challenges in continuity of care remain. CONCLUSION The study demonstrates that integrating HPV DNA testing within primary health systems through a Hub & Spoke model is feasible and effective in low-resource settings. By combining diagnostic innovation with community engagement, workforce strengthening, and cross-sector collaboration, the model provides actionable insights for scaling cervical cancer screening programmes. It highlights how locally grounded implementation can generate evidence with broader relevance for global cancer control strategies.