Determinants of participation of women in a cervical cancer visual screening trial in rural south India.

ABSTRACT

The efficacy of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in south India. Women aged 30-59 years in 113 clusters in Dindigul District were randomized to VIA screening by nurses (57 clusters, 48,225 eligible women) and to a control group (56 clusters, 30,167 women). 30,577 (63.4%) eligible women participated in screening. Younger, educated, married, multiparous, low-income women and those who have had tubal sterilization had a higher compliance with screening. Of the 2069 women diagnosed with CIN and invasive cancer, 1498 (72.4%) received treatment. Young women, those who practiced contraception and women with high-grade precursor lesions and invasive cancers were more likely to comply with treatment. In summary, our study indicates that women accept screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities, personal invitations, clinics in proximity to the target women, and testing and treatment in the same session. Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs.