Background: Cervical cancer continues to be a major cause of mortality among women in India, especially in underserved rural areas where screening uptake remains disappointingly low. Although HPV-DNA testing provides significantly higher sensitivity than conventional cytology and supports the WHO's global strategy for cervical cancer elimination, its practical implementation in resource-constrained health systems needs careful evaluation. 
In Tamil Nadu, uptake of visual inspection with acetic acid (VIA) remains low, particularly among rural women. In Kerala, VIA-based screening uptake is low due to the subjective nature of the test, shortage of trained providers, inadequate infrastructure, and lack of diagnostic and treatment services in peripheral health centers.

Objective: To generate real-world implementation evidence to improve cervical cancer screening coverage through HPV testing.

Methodology: The Access Cancer Care India project designed two complementary implementation models: a Mid-Level Service Provider (MLSP)-led HPV-based screening program in four blocks of Idukki district, Kerala Thirty-five MLSPs across 36 centres received structured training in counselling, self-sampling techniques, and triage navigation. Women aged 30–60 years were offered the choice of self-sampling or provider-assisted collection, with samples processed on the COBAS 6800 platform. 
In Tamil Nadu, a single-arm intervention trial was undertaken in selected panchayats of Mailam block, Viluppuram district, Tamil Nadu to test home-based self-sampling approach with decentralized point-of-care testing in Tamil Nadu. The model targets 2,000 eligible women aged 30–60 years through home-based HPV self-sampling. Two trained community health nurses, supported by Women Health Volunteers, conduct household visits for enrolment and sample collection. HPV DNA testing is performed using the Truenat platform (Molbio Diagnostics), a portable, chip-based real-time PCR system using HPV-HR plus kit, capable of detecting eight high-risk HPV genotypes. 
Results: Implementation is ongoing in both states and preliminary results are presented. In Kerala, of 13,259 invited women, 2,021 participated (15.2% uptake) in the study period.  99.26% (2,006/2,021) chose self-sampling, demonstrating excellent community acceptability. The HPV positivity rate was 5.1% (102/2,000). . Triage adherence was 87.25% (89/102), and 52.8% (47/89) of triaged women had pre-invasive lesions. Treatment completion reached 91.4% (43/47), supported by qualitative findings of strong motivation among MLSPs.

In Tamil Nadu, of 1,652  eligible women who had not previously attended opportunistic screening and invited, 1194 completed home-based HPV self-sampling (72.3% participation). HPV positivity was 3.3% (40/1,194). Colposcopy was completed in 55% (22/40) of HPV-positive cases, identifying one CIN II case. Validation against the COBAS 5800 platform showed 100% concordance. Recruitment continues toward the target of 2,000 participants, with HPV-positive women being actively navigated through public healthcare facilities to ensure linkage to routine standard-of-care.

Conclusion: These preliminary findings demonstrate that HPV-DNA-based screening delivered through task-shifting to community in Kerala and home-based self-sampling in Tamil Nadu is both effective and acceptable in resource-limited settings.These community-centered models support scalable implementation toward WHO cervical cancer elimination targets in LMICs.