Background and Context:
Wide availability of new, more effective molecular screening tests for cervical cancer, particularly lower-cost HPV DNA tests, are creating opportunities for low- and middle-income countries to improve their population-based screening strategies. The World Health Organization (WHO) also released new screening guidelines recommending HPV testing as a first line of screening, thus generating critical political and practical momentum. Countries are embarking on a paradigm shift away from Pap to new molecular screening tests, and facing the associated challenges of integrating these approaches into their existing infrastructure within limited budgets.
Aim:
Our aim is to facilitate the adoption of WHO screening guidelines and the introduction of new screening options in four Central American countries.
Strategy/Tactics:
We have collaborated with ministries of health, UICC, and PAHO/WHO to catalyze the necessary policy and programmatic changes to strengthen national cervical cancer programs. We have carried out stakeholder mapping exercises and preliminary needs assessments to uncover barriers and facilitators to implementing HPV DNA testing, and also held policy dialogues with multi-sector stakeholders.
Programme/Policy Process:
Several priority work areas have been undertaken, including: 1) generating buy-in from key ministerial and civil society stakeholders by updating national guidelines for cervical cancer, with input and validation from various disciplines, respected international experts, and organizations such as PAHO/WHO and UICC; 2) performing detailed situational assessments of current cervical cancer screening and treatment programs; and 3) determining immediate cost implications for the following 1–2 years including adoption, logistical implications, and allocation of human resources.
Outcomes/What was learned:
Ministries of health are committed to improving the effectiveness of screening programs and will be able to implement new screening strategies. The multi-stakeholder approaches and tools we have developed to meet specific needs for expert validation, situational assessment, and costing may be of interest to others implementing new screening strategies at the population level.