Funded by the European Union
Department of Biotechnology Government of India

Cervical cancer screening – Working in remote areas in the south of Bangladesh

implementing cervical screening in remote areas in Bangladesh

The PRESCRIP-TEC project is conducting implementation research into improving secondary prevention of cervical cancer through a unique screening method using a self-test for HPV infection. During November 2022 Dr. Jessica Vet of the Female Cancer Foundation visited southern Bangladesh to observe the progress of the project and to share her expertise.

The PRESCRIP-TEC project

This project aims to improve the secondary prevention of cervical by focusing on availability, accessibility, acceptability, and quality. The innovation lies mainly in the fact that the HPV screening test is a self-examination – in other words, the test is done by the woman herself. Experts believe that this form of testing will appeal to women and communities who are prevented from participating in gynaecological examinations for various reasons, including a lack of information and cultural barriers.

In the event of a positive test, visual inspection with acetic acid (VIA) is used to identify cervical lesions. This is a well-validated tool for use in low-resource areas and is an effective method for reducing the incidence and mortality of cervical cancer.

It is very important to undertake initiatives for screening and prevention of cervical cancer among women in the 30-60 age group. Friendship NGO has been implementing the program of cervical cancer screening and treatment, with the standard protocol which includes VIA and thermal ablation, in the northern region of Bangladesh at Floating Hospitals (EFH), two clinics at Gaibandha and Chilmari, and the Friendship Hospital Shaymnagar in the south.

Currently, PRESCRIP-TEC is collecting 3,000 HPV self-swabs from beneficiaries in the Shyamnagar area in southern Bangladesh.

On 29 November 2022, Dr. Jessica Vet, supervising doctor at the Female Cancer Foundation, visited Shyamnagar to see the activities that the local team had been conducting. Dr. Vet, together with Dr. Naheed Nazrul, Assistant Director and Quality Advisor at Friendship NGO, and Dr. Umma Kulsum, Senior Program Specialist at Friendship NGO, went to Shyamnagar Upazila and visited Abadchandipur and Sora villages to observe the outreach program activities.

Community awareness in southern Bangladesh

Awareness is the first step in community mobilisation. The southern chars of Bangladesh are included in Friendship NGO’s work to increase public awareness of cervical cancer in hard-to-reach areas.

Information and awareness-raising activities are part of the project and carried out before proceeding with the self-examination. The goal of these activities is to raise awareness of cervical cancer – in particular its origin and how it could be prevented and treated. A further goal is to encourage women to get involved in the project.

The team could show Dr. Vet the HPV collection and courtyard sessions under the PRESCRIP-TEC project in the intervention and control areas.

Service providers instruct the Friendship Community Medic-aides (FCMs), and also the beneficiaries, on how to do the self-swab collection for the HPV self-test. In addition, they monitor the quality of the samples and write the beneficiary code, date, and time on the samples as per the guidelines.

Despite awareness raising and the importance of the issue, it has been observed that not all women are enthusiastic about visiting the hospital in Shyamnagar. This is understandable as it is far away from the chars and transport is not widely available and, even if available, it is expensive. This is why the women appreciate the door-to-door service of self-swab collection which is part of the PRESCRIP-TEC project.

Sharing experience with the Friendship community members

During Dr. Vet’s visit, local teams could share and exchange knowledge with her. Besides observing courtyard sessions for community awareness and mobilisation, information and topics discussed during the visit and in the training included:

  • The steps in performing screening for high-risk HPV in the form of a self-test
  • The significance of the content of the questionnaires and the importance of their detailed completion for research purposes
  • EMR troubleshooting
  • VIA, and AI-Electronic Medical Record integration
  • HPV self-swab collection

Sharing experiences in running the PRESCRIP-TEC project in icddr’b

Dr. Vet could also engage in meetings with the International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b) team, who are in charge of conducting the research in the country, and with members from the Bangabandhu Sheikh Mujib Medical University (BSMM).

During the meetings, Dr. Aminur Rahman, Ms. Anika, Dr. Naheed, Dr. Kulsum, Md. Shahnur Ahmed Shaown, and other members of the team were able to discuss the progress of PRESCRIP-TEC and the impact its implementation can have at the national level. This looks like a very promising option for eliminating cervical cancer in Bangladesh.