Background: Oral cancer accounts for 30% of all cancers in India. HIV-induced immunosuppression is a risk factor for cancer. Tobacco, alcohol use and oral HPV: risk factors for oral cancer are common among PLWH. Screening for oral cancer in India is sparse and patient to provider ratio high. We evaluated a novel m-Health oral cancer screening approach for PLWH led by non-medical healthcare workers.
Description: Employing a validated oral cancer screening mobile application, PLWH (≥21 years) with no prior history of oral cancer were enrolled June to November 2017 at the ART clinic, Sassoon General Hospitals, Pune, India. Two trained non-medical healthcare workers obtained demographic, HIV, cancer risk factor data and took 8 or more photographs of the oral cavity using a smartphone. Photographs were uploaded to a cloud-based server and reviewed independently by two oral cancer specialists for oral potentially malignant disorders (OPMDs). If disagreement occurred, a third independent senior specialist adjudicated. Image review results were communicated to the healthcare workers. Individuals deemed to have OPMDs were contacted for an in-person clinical evaluation by a specialist and provided additional care as necessary.
Lessons learned: Of 331 enrollees, 50% were male, median age was 40 years (IQR: 34 -45), median CD4 was 529 cells/mm³ (IQR: 366 - 727), 15% ever smoked, 2% currently smoked; 39% ever chewed tobacco, 26% currently chewed tobacco; 35% ever used alcohol and 1% drank currently. Oral sex was reported by 15% and multiple sexual partners by 29%. Of 2648 images reviewed, 99% were deemed adequate for making a clinical diagnosis; 42 participants (13%) were judged to have OPMDs by two clinicians. They were older (p=0.01), more likely to be male (p=0.05). Of the 42, 36% did not return after being contacted. Of 27 who returned, 52% were diagnosed with OPMDs on clinical examination and provided standardized care.
Conclusions/Next steps: In a cohort with high CD4 count, prevalence of oral cancer risk factors was high. While OPMDs were overdiagnosed on image review, m-Health provided an effective and rapid method of oral cancer screening, without overburdening providers.Scaling up of this strategy will however require better risk communication to improve participant follow-up.

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