• The objective was to identify the barriers and challenges faced by providers and vulnerable populations in low-resource settings and adopt strategies to implement a feasible HPV test-based cervical cancer screening program.

• A mixed-method, quasi-experimental trial design, including qualitative and quantitative assessments, was utilized.

• Strategies involved-

1. Capacity assessment,

2. Workshops and training,

3. Community engagement, and

4. Counseling by frontline health care workers.

• The results of the study are as follows:

1. Achievment of 30% screening uptake in 8 months, compared to 6-8% with visual inspection methods annually.

2. The highest HPV positivity was found among tribal women (12.1%), followed by rural (5.5%) and urban slum women (3.1%).

3.  Follow-up rate for triage testing: rural (84.6%), tribal (56.1%), urban slum (45.5%).

4. Special follow-up camps increased the tribal follow-up rate to 56%.

5. Median time from HPV report to follow-up: tribal (28 days), urban slum (36 days), rural (36 days).

• The challenges with VIA-based screening were addressed, including, hesitancy, limited camps, and personnel shortages.

• The flexibility in service delivery and patient navigation improved screening uptake and compliance.

• The self-collection of samples combined with community engagement, flexible triage processes, and health system strengthening showed acceptable screening rates and better compliance to triage.

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