A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities

Abstract

The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.

Effect of Health Education on the Knowledge of Cervical Cancer, Human Papillomavirus and Self-sampling Among Women in a Low- Resource Setting

“…Over the next 12 years (2018 to 2030) the annual number of new cases of cervical cancer is expected to increase from 570,000 to 700,000. During that same period the annual number of deaths from cervical cancer will increase from 311,000 to 400,000 [2]. More than 85% of those affected are young, poor, undereducated women who live in the world's poorest countries.…”

Sequential Application of Lugol’s Iodine Test after Acetic Acid for Detecting Cervical Dysplasia: A Prospective Cohort Study

“…In summary, the results of our study add to the literature describing an evidence-based and rational use of diagnostic tests for the work-up of women with cervical dysplasia. This is of clinical relevance because cervical dysplasia is a common disorder affecting millions of women worldwide [ 1 , 2 , 3 , 4 , 7 ]. We propose that Lugol’s iodine test should be performed subsequent to the AA test in all women undergoing colposcopy for suspected cervical dysplasia.…”

“…Cervical dysplasia is an important health issue affecting women of all ages [ 1 , 2 ]. Detecting and removing high-grade squamous intraepithelial lesions (HSIL) before they develop into invasive cervical cancer is the main goal of cervical cancer screening and an important goal of medical care of women worldwide [ 3 , 4 ]. Both cervical neoplasia and cervical cancer have profound impacts on the health and quality of life of affected women [ 5 , 6 ].…”

Impact of one and two human papillomavirus (HPV) vaccine doses on community-level HPV prevalence in South African adolescent girls: study protocol and rationale for a pragmatic before–after design

“… 17 The main barriers include vaccine cost, delivery cost and delivery complexity for the target age group. 18 Consequently, reducing the number of doses in the HPV schedule has become a key strategy to improve global vaccine coverage. Studies have shown that two doses administered to pre-adolescents with wider spacing between doses is serologically equivalent to three doses in adult women.…”

“…Despite substantial evidence for the benefits of HPV vaccines, uptake has been poor in many LMICs 17. The main barriers include vaccine cost, delivery cost and delivery complexity for the target age group 18. Consequently, reducing the number of doses in the HPV schedule has become a key strategy to improve global vaccine coverage.…”