Despite being preventable and curable cervical cancer remains 4th biggest cancer in women

PART-II

Raising cervical cancer awareness and health literacy among people with HIV

As women living with HIV are 6 times more at risk of cervical cancer, communities and networks of people with HIV must come forward to find ways to integrate cervical cancer screening as well as for other cancers (such as breast cancer) programmatically and in people-centred manner, said Daxa Patel, co-founder of National Coalition of People living with HIV in India (NCPI Plus) and its former President.

Agrees Pooja Mishra, Secretary of NCPI Plus that it is unacceptable when cervical cancer, which is preventable and curable - and the only cancer which can be eliminated - still kills 350,000 women worldwide. We also need to raise awareness, health and treatment literacy among the young people, said Mishra.

That is why NCPI Plus took leadership in organising a national dialogue and stakeholder consultation on preventing cancers among people with HIV, especially women.

TruenatHPV-HR Plus test is critical for closing the screening gap, particularly for asymptomatic women and women who are at higher risk for persistent HPV infection. By shifting HPV screening closer to the most-at-risk people and communities, this test ensures early detection, better triaging, and timely treatment - especially in historically underserved populations.

Over 10,000 TruenatRT-PCR molecular test machines are already deployed globally in over 85 countries (mostly for TB), and mostly in the Global South nations in remote settings. Truenat is a battery operated (with solar power charging), laboratory independent, de-centralised and point-of-care test that provides highly accurate diagnosis for over 30 diseases (including TB, HPV, HCV, HBV, STIs, COVID-19, etc) within an hour – thus enabling same day test and treat, counselling and follow-up.

Superiority of TruenatHPV-HR Plus test

Older Pap smear test detects precancerous or cancerous cervical cancer cells whereas TruenatHPV-HR Plus test detects the presence of high-risk HPV DNA (8 genotypes).

Pap smear is a cytological screening test and depends on the observing medical expert’s skill and slide quality, whereas Truenat is a PCR-based nuclear acid amplification test with very high sensitivity and specificity.

False negative reports are higher and false positive reports are also moderate when pap smear is used whereas both are low with TruenatHPV-HR Plus. The most recent validation of TruenatHPV-HR Plus showed 100% specificity and 100% sensitivity.

TruenatHPV-HR is designed to work with cervical swab samples collected by a clinician (self-collection of samples is still under evaluation), and it gives highly accurate results in just 60 minutes. Whereas, a pap smear results may take 3-7 days as these are laboratory dependent.

Easy to use and with high stability at room temperature, TruenatHPV-HR Plus requires minimal biosafety and is optimised for use at both the laboratory and near-patient settings. This test overcomes shortcomings of current diagnostic methods, including variable sensitivity and specificity, high costs, complex workflows, and dependence on advanced equipment, said Dr Sachdeva.

Highlighting the importance of developing health technologies in the Global South, Rajesh S Gokhale, Secretary, Department of Biotechnology, Ministry of Science and Technology, Government of India said, “TruenatHPV-HR Plus represents the kind of diagnostic innovation we need - dependable, scientifically rigorous, locally developed, and built to serve our public health system. It is a huge step forward in strengthening cervical cancer screening across India.”

"HPV infection is common. However, persistence of HPV infection could be deadly. Studies show that nearly half of persistent HPV infections do not resolve by 24 months. These silent carriers drive the progression to high-grade pre-cancerous lesions and cancer. That’s why extended HPV genotype detection is crucial," shared Dr Sachdeva.

HPV also causes oropharyngeal cancers

Oropharyngeal cancers related to HPV vary from 28% to 68% in the richer nations. Indian studies also show alarming numbers though, more research is needed for science-informed responses towards eliminating HPV related cancers in our population, said Dr IshwarGilada, President Emeritus of AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS).

“While there is increasing evidence of HPV-associated oropharyngeal cancer in both men and women globally, there still remain gaps in gender-neutral HPV vaccination policies globally,” said Dr Sachdeva.

Community leaders like Manoj Pardeshi, who is among the co-founders and inspiring lights of NCPI Plus, said that regardless of gender, all those eligible and at risk of HPV related cancers, must be vaccinated against HPV. Programme addressing cervical cancer elimination should expand to eliminate all HPV related cancers in people-centred ways, regardless of gender.

HPV is transmitted through:

Sexual contact: Transmission mode is through vaginal, anal, or oral sex with an infected person.

Skin-to-skin contact: Transmitted through non-penetrative sexual activities involving skin-to-skin contact.

The WHO Guidelines recommend HPV detection via molecular test after age of 30 (and every 5 years thereafter). Vaccination against HPV is highly recommended for younger people under the age of 15 or before the initiation of sexual activity.

Do not leave equity behind

“TruenatHPV-HR Plus test is about equity in detection. By expanding beyond traditional targets, we reach the genotypes that matter more in our populations for cervical cancer elimination. This means earlier intervention, fewer missed cases, and better outcomes,” said Dr Sachdeva. TruenatHPV-HR Plus offers the best of both worlds - critical genotype coverage and real-world deploy-ability.

What does it mean to eliminate cervical cancer by 2030?

To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below 4 per 100,000 women. Achieving that goal rests on three key pillars and their corresponding targets:

Vaccination: 90% of all eligible young people must be fully vaccinated with the HPV vaccine by the age of 15.

Screening: 70% of women should be screened using a high-performance test by the age of 35, and again by the age of 45;

Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

No other cancer but cervical cancer is fully preventable and curable if detected and managed early. Even one death from it is a death too many.

CONCLUDED

 (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She also coordinates SHE & Rights initiative (Sexual health with equity & rights)