Acting on the call for cervical cancer elimination: Planning tools for low- and middle- income countries to increase the coverage and effectiveness of screening and treatment

Abstract

Introduction Accessible planning tools tailored for low-and middle-income countries can assist decision makers in comparing implementation of different cervical cancer screening approaches and treatment delivery scenarios in settings with high cervical cancer burden. Methods The Cervical Precancer Planning Tool (CPPT) was developed by PATH for users to explore and compare the accuracy of screening approaches, what treatment equipment to procure, and how best to deploy treatment equipment in a given country. The CPPT compares four screening approaches: 1) visual inspection with acetic acid (VIA), 2) HPV testing, 3) HPV testing followed by a VIA triage, and 4) HPV testing followed by an enhanced triage test. Accuracy of screening outcomes (e.g., true positives, false positives) is based on published sensitivity and specificity of tests to detect cervical precancerous lesions. The CPPT compares five scenarios for deploying ablative treatment equipment: 1) cervical precancer equipment at every location a woman is screened (single visit approach), 2) equipment only at a hospital level, 3) a single unit of equipment in each district, 4) allowing two districts to share a single unit of equipment, and 5) equipment placed at select district hospitals paired with mobile outreach. Users can customize the CPPT by adjusting pre-populated baseline values and assumptions, including population estimates, screening age range, screening frequency, HPV and HIV prevalence, supply costs, and health facility details. Results The CPPT generates data tables and graphs that compare the results of implementing each of the four screening and five treatment scenarios disaggregated by HIV status. Outputs include the number and outcomes of women screened, cost of each screening approach, provider time and cost saved by implementing self-sampling for HPV testing, number of women treated, treatment equipment needed by type, and the financial and economic costs for each equipment deployment scenario. Conclusion The CPPT provides practical information and data to compare tradeoffs of patient access and screening accuracy as well as efficient utilization of equipment, skilled personnel, and financial resources. Country decision makers can use outputs from the CPPT to guide the scale-up of cervical cancer screening and treatment while optimizing limited resources.

HPV-Based Self-Sampling in Cervical Cancer Screening: An Updated Review of the Current Evidence in the Literature

“…With similar laboratory performance of self-sampling procedures to clinician-performed sampling, high participation and reported satisfaction rates for the individuals, there is clear potential for increasing overall cervical cancer screening uptake with VSS in this population and maximizing efficiency and cost-effectiveness, essentially implementing the same networks and infrastructures, with comparatively lower additional costs. This gains additional importance, given the contribution of underserved patients living with HIV in the global burden of cervical precancer and cancer morbidity and mortality [ 42 , 43 ].…”

COVID-19 as a catalyst for reimagining cervical cancer prevention

“…Coordinated research on HPV triage with pooled genotyping, biomarkers, methylation, and artificial intelligence is necessary for effective programming (recommendation 8). Cost analysis at the country level using existing open-access tools will be necessary to ensure integration of more effective technologies ( Herrick et al, 2022 ). Patient navigation to ensure that women who screen HPV positive return for triage and treatment is essential.…”

Cost‐effectiveness analysis of alternative screening strategies for the detection of cervical cancer among women in rural areas of Western Kenya

“…The p16/Ki67 dual‐stain cytology test 33 detects a transforming HPV infection with a high sensitivity and specificity 34 . Dual‐stain cytology has been recommended as a high‐performance triage marker in high‐income countries 35 and its feasibility to be used as an “enhanced triage test” 28 also for LMICS depends highly on its technical and economic requirements.…”

“…In multiple studies from LMICs, the cost-effectiveness of HPVbased screening, [20][21][22][23][24] the acceptance of HPV self-sampling and its potential for easier screening access and increased screening coverage [25][26][27][28] have been documented. A number of triage tests for LMICs are under investigation, including VIA, genotyping, digitally enhanced VIA, automated visual inspection, and biomarkers.…”