Strengthening Cervical Cancer Screening Uptake Using Primary Care Integration and Standardized Community Education in Rural South India

PURPOSE Cervical cancer screening coverage in India remains extremely low, with only 1.9% of women aged 30-49 reporting ever having been screened. Low awareness and perceived susceptibility further limit uptake. HPV-DNA testing using self-collected samples offers a scalable approach. We evaluated a community-based screening model integrating contextually-grounded education within primary healthcare systems using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to assess outcomes. METHODS Using a quasi-experimental design, we evaluated the implementation of HPV-DNA–based cervical cancer screening using self-collected vaginal samples across 22 villages served by two Primary Health Centers (PHCs) in Mysore district, India, from May 2025 to April 2026. Both PHCs served demographically comparable rural populations. In the first PHC, screening was implemented using a non-standardized approach characterized by variation in education content and delivery and limited integration of community health workers (CHWs). Based on these implementation learnings, a standardized model was subsequently introduced in a second PHC. Pre-implementation activities included stakeholder engagement, assessment of local barriers and beliefs, training of PHC staff, and coordinated involvement of CHWs. A community-informed education strategy using multimedia and flip charts was delivered in group and door-to-door settings. Following counseling and informed consent, women self-collected vaginal samples for HPV-DNA testing, and results were returned confidentially. RESULTS In the first PHC, 43.6% (1,288/2,955) of eligible women underwent screening over eight months. In the second PHC, 69.9% (1,058/1,513) of eligible women were reached through education and 60.3% (913/1,513) completed screening within four months, with 86.3% uptake among women who received education. Compared with the first PHC, this represented a 16.7 percentage-point absolute increase and a 38.3% relative increase in screening uptake, achieved in half the implementation time. Low perceived susceptibility remained the primary barrier to participation in both PHCs (56.2% vs 55.3% of non-participants). These findings suggest that standardized education, coordinated CHW engagement, and integration within primary care systems involving all PHC cadres can substantially improve HPV screening uptake. CONCLUSION Embedding HPV screening within primary healthcare systems improved implementation efficiency and substantially increased participation. Persistent gaps in perceived risk highlight an important behavioral barrier requiring targeted communication strategies.