# Role of Training Paramedical Staff for Cervical Cancer Screening via Human Papillomavirus Self-Sampling in Remote Mountainous Regions: A Pilot Feasibility Study

## TL;DR

A pilot study in a remote Indian region found that training paramedical staff to help women collect HPV self-samples for cervical cancer screening is feasible and well-accepted.

## Contribution

The study introduces a novel approach to cervical cancer screening in remote areas by training paramedical staff to facilitate HPV self-sampling.

## Key findings

- 94% of counseled women consented to HPV self-sampling.
- One woman (2.1%) tested positive for high-risk HPV.
- The approach was found to be feasible and acceptable in a remote mountainous region.

## Abstract

Background

Cervical cancer is the second most common cancer among women in India and a leading cause of cancer-related deaths in low- and middle-income countries. Despite the availability of effective screening methods, coverage remains low in India due to limited awareness, logistical barriers, and poor access, especially in remote regions. The World Health Organization recommends human papillomavirus (HPV) DNA testing as the preferred screening method, and self-sampling has emerged as a promising strategy to increase participation. This study aimed to evaluate the feasibility and acceptability of HPV self-sampling for cervical cancer screening through trained paramedical staff in a community-based pilot study conducted in a remote mountainous region of Ladakh, India.

Methodology

This was a pilot, observational feasibility study conducted during a community-based health camp in Kargil, Ladakh. Paramedical staff (auxiliary nurse midwives) were trained through demonstrations and videos to counsel women on HPV self-sampling. Women were educated and offered self-sampling kits (Digene HC2 High-Risk HPV DNA, Qiagen). Samples were collected on-site and transported to New Delhi for testing. Reports were shared via mobile phone and followed up by local gynecologists.

Results

Of the 50 women counseled, 47 (94%) consented to HPV self-sampling. One tested positive (2.1%) for high-risk HPV and was referred for further evaluation. The high acceptability indicates the feasibility of this approach in remote areas.

Conclusions

This pilot study demonstrates that training paramedical staff for HPV self-sampling facilitated by trained paramedical staff appears to be a feasible and acceptable approach for cervical cancer screening in remote settings. This approach can bridge screening gaps and support national efforts toward cervical cancer elimination.