**8.1 The development of the STAR model P-6 principles of raj©**

The author, having been successful in planning and implementing, such a model, and achieving a reduction in the incidence rate of cervical cancer by 25% and *HPV and Cervical Cancer Control Programs: Effective Translation of Knowledge into Practice DOI: http://dx.doi.org/10.5772/intechopen.91313*

mortality due to cervical cancer by 35%, in a period of 7 years—2000 to 2007, strongly recommends the STAR model P-6 principles of Raj©.

He has served as the principal investigator for the first 3 years, and the project was done at the Christian Fellowship Community Health Centre Society, Ambilikkai, Dindigul district, Tamil Nadu, India, and was in technical collaboration with the International Agency for Research on Cancer (IARC), WHO.

## **9. Background**

vaccination programs on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men, programs with multi-cohort vaccination and high vaccination coverage had a greater direct impact

Ref: *Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis Drolet M, Bénard É, Pérez N, Brisson M, on behalf of the HPV Vaccination Impact*

2.Human papillomavirus (HPV) vaccination significantly reduces the frequency of genital HPV 16 and 18 infections and cervical intraepithelial neoplasia grade 2+ (CIN2+) in young women and shows signs of herd effects with a reduced frequency of anogenital warts in both young women and men, a recent study

9/16/2019 HPV vaccination programmes reduce HPV infection, precancerous lesions with potential crossover and herd effects | News for Doctor, N.

https://specialty.mims.com/topic/hpv-vaccination-programmes-reduce-hpvinfection–precancerous-lesions-with-potential-crossover-and-herd-effects-? …

Results: We observed that despite good knowledge and perception, less than 10 percent of workers have undergone screening. Significant association was seen

Conclusion: It is of utmost importance narrowing of existing gap between the

Screening should be initiated through introducing more educational programs

The study cited is from: Khanna D, Khargekar N, Budukh A. Knowledge, atti-

Author's experiences in a cervical cancer screening program of the IARC/WHO,

The author, having been successful in planning and implementing, such a model, and achieving a reduction in the incidence rate of cervical cancer by 25% and

tude, and practice about cervical cancer and its screening among community healthcare workers of Varanasi district, Uttar Pradesh, India. J Family Med Prim

**7. KAP studies reveal the presence of adequate knowledge but**

**inadequate "practice "in the community**

between the level of knowledge and practice of screening.

**8. How to translate "knowledge" in to "practice"**

**8.1 The development of the STAR model P-6 principles of raj©**

perception and practice of cervical cancer.

for workers and encouraging them to participate.

and herd effects.

*Human Papillomavirus*

showed.

1/7.

As cited in infectious diseases.

**7.1 Recent study in India**

Care 2019;8:1715–9.

In India.

**108**

*Study Group. The Lancet. Open access*

Proof of concept (POC)—The Lancet Publication 2007, the author's paper. Quote:

Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomized trial.

Lancet 2007; 370(9585):398-406.

Rengaswamy Sankaranarayanan, Pulikkottil Okkuru Esmy, Rajamanickam Rajkumar, et al.

### **10. Summary**

Cervical cancer is the most common cancer among women in developing countries. We assessed the effect of screening using visual inspection with 4% acetic acid (VIA) on cervical cancer incidence and mortality in a cluster-randomized controlled trial in India.

### **11. Methods**

Of the 114 study clusters in Dindigul district, India, 57 were randomized to one round of VIA by trained nurses and 57 to a control group. Healthy women aged 30– 59 years were eligible for the study. Screen-positive women had colposcopy, directed biopsies, and, where appropriate, cryotherapy by nurses during the screening visit. Those with larger precancerous lesions or invasive cancers were referred for appropriate investigations and treatment.

Cervical cancer incidence and mortality in the study groups were analyzed and compared using Cox regression taking the cluster design into account, and analysis was by intention to treat. The primary outcome measures were cervical cancer incidence and mortality.

### **12. Results**

Of the 49,311 eligible women in the intervention group, 31,343 (636%) were screened during 2000–2003; 30,958 control women received the standard care. Of the 3088 (99%) screened positive, 3052 had colposcopy and 2539 directed biopsy. Of the 1874 women with precancerous lesions in the intervention group, 72% received treatment. In the intervention group, 274,430 person years, 167 cervical cancer cases, and 83 cervical cancer deaths were accrued compared with 178,781 person years, 158 cases, and 92 deaths and in the control group during 2000–2006 (incidence hazard ratio 075 [95% CI 055–095] and mortality hazard ratio 065 [047–089]).
