Nathalie Broutet1, Jose Jeronimo2, Somesh Kumar3, Maribel Almonte4, Raul Murillo5, Nguyen Vu Quoc Huy6, Lynette Denny7, Sharon Kapambwe8, Neerja Bhatla9, Motshedisi Sebitloane10, Fanghui Zhao11, Patti Gravitt12, Prajakta Adsul13, Ajay Rangaraj14, Shona Dalal14, Morkor Newman14, Raveena Chowdhury15, Kathryn Church15, Carol Nakisige16, Mamadou Diop17, Groesbeck Parham18, Kerry A Thomson19, Partha Basu4, Petrus Steyn14. 1. World Health Organization, Geneva, Switzerland. Electronic address: broutetn@who.int. 2. Consultant for the US National Cancer Institute, MD, USA. 3. Jhpiego, Baltimore, MD, USA. 4. International Agency for Research in Cancer (IARC), Lyon, France. 5. Centro Javeriano de Oncología, Bogota, Colombia. 6. Hue University of Medicine and Pharmacy, Hue, Viet Nam. 7. University of Cape Town, Cape Town, South Africa. 8. Ministry of Health, Lusaka, Zambia. 9. All India Institute of Medical Sciences, New Delhi, India. 10. University of KwaZulu Natal, Durban, South Africa. 11. Chinese Academy of Medical Sciences, Beijing, China. 12. University of Maryland Baltimore, Baltimore, MD, USA. 13. University of New Mexico Comprehensive Cancer Center, USA. 14. World Health Organization, Geneva, Switzerland. 15. Marie Stopes International, London, UK. 16. Uganda Cancer Institute, Kampala, Uganda. 17. Cancer Institute, Le Dantec Hospital, Cheikh Anta Diop University, Senegal. 18. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 19. PATH, Sexual & Reproductive Health Program, Seattle, WA, USA.
Abstract
BACKGROUND: Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem. MAIN BODY: New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts. CONCLUSION: For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.
BACKGROUND: Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem. MAIN BODY: New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts. CONCLUSION: For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.
Authors: Helen Kelly; Iman Jaafar; Michael Chung; Pamela Michelow; Sharon Greene; Howard Strickler; Xianhong Xie; Mark Schiffman; Nathalie Broutet; Philippe Mayaud; Shona Dalal; Marc Arbyn; Silvia de Sanjosé Journal: EClinicalMedicine Date: 2022-09-27