Commentary: Advancing the Science of Implementation for Resource-Limited Settings through Bidirectional Learning Around Cervical Cancer Screening

Abstract

In 2020, the highest rates of cervical cancer incidence and mortality were reported in Asian and African regions of the world. Across the globe, growing evidence confirms cancer disparities among racial and ethnic minorities, low socioeconomic status groups, sexual and gender minorities, uninsured individuals, and rural residents. Recognition of these stark disparities has led to increased global efforts for improv­ing screening rates overall and, in medically underserved populations, highlighting the urgent need for research to inform the suc­cessful implementation of cervical cancer screening. Implementation science, defined as the study of methods to promote the integration of research evidence into health care practice, is well-suited to address this challenge. With a multilevel, implementa­tion focus, we present key research direc­tions that can help address cancer dispari­ties in resource-limited settings. First, we describe several global feasibility studies that acknowledge the effectiveness of self-sam­pling as a strategy to improve screening cov­erage. Second, we highlight Project ECHO as a strategy to improve providers’ knowl­edge through an extended virtual learning community, thereby building capacity for health care settings to deliver screening. Third, we consider community health work­ers, who are a cornerstone of implement­ing public health interventions in global communities. Finally, we see tremendous learning opportunities that use contextually relevant strategies to advance the science of community engagement and adaptations that could further enhance the uptake of screening in resource-limited settings. These opportunities provide future directions for bidirectional exchange of knowledge between local and global resource-limited settings to advance implementation science and address disparities. Ethn Dis. 2022; 32(4):269-274; doi:10.18865/ed.32.4.269

Strategies for primary HPV test-based cervical cancer screening programme in resource-limited settings in India: Results from a quasi-experimental pragmatic implementation trial

“…In a recent commentary, Prajakta Adsul et al noted the WHO working group's recommendation on need for more implementation research with a specific focus on broadening stakeholder engagement, equity in reach and navigation throughout the continuum of care, and improving the readiness of health systems to increase adoption and implementation of cervical cancer screening programs. The authors highlighted the key research advances within the resource-limited settings that could contribute towards enhancing the science of implementation around global cervical cancer screening efforts [19,20].…”