HPV DNA test, not cytology
WHO recommends HPV DNA as the primary method. In Kalutara it found more precancer than cytology among 1,012 women.
For health partners and supporters
An evidence-based pilot to close the estate screening gap
AUD 407,525 over 24 months, about AUD 86 per valid HPV result, delivered through government health services.
The gap in numbers
Coverage is not reported separately for the estate sector, so this gap is invisible in routine data.
| Measure | Estate or district | Comparison | Source |
|---|---|---|---|
| Cervical cancer incidence (registry) | 14 / 100,000 (Nuwara Eliya) | 9.2 / 100,000 national ASR | FPA, 2024 |
| Ever had a Pap test | 9% estate | 18% urban · 22% rural | FHB & UNFPA, 2019 |
| Heard of Well Woman Clinics | 32% estate | 61% urban · 74% rural | FHB & UNFPA, 2019 |
| District Pap coverage, 2023 | 65.5% (35) · 48.2% (45) | Targets 80% · 60% | FHB, 2024 |
| Serious problem accessing care | 77% plantation women | 47.3% national | Verité Research, 2024 |
| Multidimensional poverty | 44.2% Nuwara Eliya | 16.0% national | DCS, 2023 |
Why this design: the evidence
Self-collected samples
PCR tests on self-samples are as sensitive as clinician samples (relative sensitivity 0.99). In Sri Lanka, vaginal and cervical specimens agreed closely (sensitivity 100%, specificity 98.9%).
Kits offered in person by PHMs
Across 33 trials, community outreach raised participation by 39.1 points, against 13.2 for mail-to-all and 4.4 for opt-in.
Built-in navigation to treatment
Self-sampling roughly doubles uptake (RR 2.13) but not linkage to care. In Kalutara, 86.7% of referred women sought colposcopy, with repeat visits from congestion and travel.
Genotyping triage
HPV 16/18 go straight to colposcopy; other high-risk types get triage cytology, keeping referrals within capacity.
Wages and work time protected
Transport costs and lost work time keep many women in LMICs from screening.
Policy fit
Sri Lanka's national strategic plan commits to phasing in HPV DNA testing with self-collected samples and names estate women as a priority group (NCCP, 2020). The 2025 imPACT review recommended completing the HPV pilot with self-sampling in hard-to-reach areas (NCCP & IAEA, 2025). Kushalam is proposed for support under Objective 3 of the Australia–Sri Lanka Development Partnership Plan 2025–2030 (DFAT, n.d.).
Quality gates before each expansion
If a wave misses a gate, expansion waits up to a month under a corrective plan. A second miss ends expansion, and unspent funds are returned to DFAT or reprogrammed with its agreement.
August 2027
Gate 1 · → 8 estates
- Consent ≥85%
- Invalid samples ≤5%
- Median turnaround ≤28 days
- Booth throughput on plan
- No confidentiality breach
November 2027
Gate 2 · → 12 estates
- All Gate 1 measures
- ≥95% of valid results acknowledged within 30 days
- Colposcopy referrals within agreed capacity
February 2028
Gate 3 · → 20 estates
- Waves 1–2 cover ≥60% of the line list
- ≥80% of Wave 1 referrals linked within 3 months
- Spending within ±10%
Monitoring, evaluation and handover
Monitoring uses existing government records, with no parallel database. An independent Sri Lankan research team will run a mixed-methods RE-AIM evaluation at endline (Glasgow et al., 1999). Without a comparison group, findings will show feasibility and contribution, not effects on cancer incidence.
After December 2028, kits and tests (about US$13.50 per woman) move to national HPV procurement, and companies continue booth space and work time under the MOU. A shadow phase from July to September 2028 has MOH teams run results and navigation without project staff.
What your support provides
Indicative cost per woman
AUD 86
Covers invitation, self-test, lab result, follow-up and treatment support for each of about 4,760 women with a valid result (70% of 6,800).
Where every AUD 100 goes
AUD 35
Personnel and allowances
AUD 29
HPV tests, kits and equipment
AUD 21
Transport, vehicles, women’s travel and wages
AUD 7
Indirect costs (7%)
AUD 4
Contingency (5%)
AUD 4
Trainings and meetings
Budget
| Category | Total (AUD) |
|---|---|
| Personnel and allowances | 140,868 |
| HPV tests, kits and equipment | 118,702 |
| Transport, vehicles, women’s travel and wages | 85,453 |
| Indirect costs (7%) | 26,660 |
| Contingency (5%) | 18,136 |
| Trainings and meetings | 17,706 |
| Total | 407,525 (LKR 94,138,065) |
Year 1 (AUD 190,507) covers set-up and Waves 1–2. Year 2 (AUD 217,018) covers Waves 3–4, follow-up, evaluation and handover. The Government of Sri Lanka co-finances in kind through staff, laboratory, clinic and treatment services.
About the full proposal