CATCH - Community Access to Cervical Health

  • Dr. Kalpana Betha, MD, Prof & HOD, MIMS
  • Dr. Meenakshi Jain, MD, Obgy.
  • Prof. Keerthi Shah, MD, Johns Hopkins University
  • Prof. Patti E. Gravitt, Johns Hopkins University

SHARE INDIA jointly with Johns Hopkins University to evaluate various strategies in screening the population for Cervical Cancer. Johns Hopkins University was funded by NIH; SHARE INDIA was funded by Department of Biotechnology, under Indo American joint collaboration. The project was initiated in 2002 and completed in 2009, under the guidance of Prof. Keerti Shah and implemented by his associate Dr. Patti Gravitt.


Invasive cervical carcinoma is a major cancer of women in the developing world. Nearly one-fourth of the new cervical cancer cases worldwide is estimated to occur in India, where a large majority is identified in an advanced and inoperable stage of disease. This is a public health tragedy, since among all major human cancers; cervical cancer is potentially the most preventable. It can be easily diagnosed in its pre-invasive stage, because the cervix is readily accessible for inspection and sampling and pre-invasive cervical abnormalities persist for many years and can be effectively treated.


The CATCH Study is designed as a population-based study to evaluate the performance of three cervical cancer screening assays in rural India: Pap smear, HPV DNA testing and visual inspection of the cervix after acetic acid application (VIA).


To compare the test characteristics (sensitivity, specificity, positive and negative predictive values and referral to colposcopy rates) of each of the following three screening methods for the detection of prevalent high-grade squamous intra-epithelial lesions (HSIL) and/or invasive cervical carcinoma:

  • Pap smear
  • Visual inspection of cervix (VIA)
  • HPV DNA in clinician collected specimens (HPV-C)

The study aimed to enroll all eligible women,25 years and older, who were not pregnant and had not had a hysterectomy. A total of 2331/5603 (41.6%) eligible women enrolled between January 2005 and July 2007.Participants consented to an interviewer administered questionnaire and also provided biological specimens. All women found to have one or more positive tests (n= 582) were invited back for colposcopic examination and biopsy where indicated. Of the 19 women identified with CIN2+ lesions, 5 were VIA +ve(26.3%) 12 women were Pap positive(63.2%) anf 16 women were HPV (84.2%). As only 41% were enrolled in to the study, we developed education materials and conducted in depth interviews and focus group discussions to elicit knowledge, attitudes and beliefs about cervical cancer. Majority accepted the idea of field based vaginal sampling. Agreement between self collected vaginal and physician collected cervical PCR based HPV detection was 93%.


The HPV test was more sensitive and specific relative to the subjective Pap and VIA tests. Compliance with screening, follow up and treatment remained a significant barrier to effective cervical cancer prevention in rural India.


    1. Sowjanya P*, Jain M, Rani U, Padma S, Das M, Shah KV, Rao BN, Ramadevi R, Gravitt P, Ramakrishna G. Prevalence and distribution of high-risk HPV types in invasive squamous cell carcinoma of the cervix and in normal women in Andhra Pradesh, India. BMC Infect Dis. 2005;5(1):116.
    2. Sowjanya AP*, Paul P, Vedantham H, Ramakrishna G, Vidyadhari D, Vijayaraghavan K, Laksmi S, Sudula M, Das M, Shah KV, Gravitt PE, for the CATCH Study Group. Suitability of self-collected vaginal samples for cervical cancer screening in peri-urban villages in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1373-8.
    3. Vedantham H, Silver MI, Kalpana B, Rekha C, Karuna BP, Vidyadhari K, Mrudula S, Ronnett BM, Vijayaraghavan K, Ramakrishna G, Sowjanya P, Laxmi S, Shah KV, Gravitt PE, for the CATCH Study Team. Determinants of VIA (visual inspection of the cervix after acetic acid application) positivity in cervical cancer screening of women in a peri-urban area in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev. 2010;19(5):1373-80.
    4. Gravitt PE, Paul P, Katki HA, Vedantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KV. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PLoS ONE. 5(10):e13711. doi:10.1371/journal.pone.0013711.
    5. Piyathilake CJ, Badiga S, Paul P, Vijayaraghavan K, Vedantham H, Sudula M, Sowjanya P, Ramakrishna G, Shah KV, Partridge EE, Gravitt PE. Indian women with higher serum concentrations of folate and vitamin B12 are significantly less likely to be infected with carcinogenic or high-risk (HR) types of human papillomaviruses (HPVs). Int J Women Health. 2010;2:7-12
    6. Silver MI*, Paul P, Sowjanya P, Ramakrishna G, Vedantham H, Kalpana B, Shah KV, Gravitt PE. Shedding of Epstein-Barr virus and cytomegalovirus from the genital tract of women in a peri-urban community in Andhra Pradesh, India.