Miriam Cremer

Adoption and Implementation of Affordable Cancer Technologies in El Salvador: Identifying Implementation Strategies for Successful Cervical Cancer Prevention in Resource-Limited Settings

As part of the affordable cancer technology program, our team developed and tested a portable thermal ablation (TA) cervical precancer treatment. This research helped support subsequent implementation of the technology in El Salvador. Here, we review successful implementation strategies deployed during the process and point to challenges and implications for other low- and middle-income countries (LMICs). We use the exploration, preparation, implementation, and sustainment framework to guide the discussion and identify associated implementation strategies used during each phase. Significant strategies were the development and maintenance of multi-actor partnerships and accessing new funding to introduce innovations to the country. In this case, planning for implementation began before the decision to adopt TA. The case of El Salvador highlights the need for such pragmatic approaches to shorten the time between scientific research and clinical practice in LMICs. The impact of these efforts has been significant: El Salvador has gone from one of the countries with the lowest cervical cancer screening rates in the region to one that can potentially meet elimination targets in the coming decades. This experience can serve as a blueprint for cervical cancer control efforts in other LMICs.

Use of Thermal Ablation in Low-Resource Settings: Experience From Three Multicenter Noninferiority Randomized Clinical Trials

PURPOSE Thermal ablation (TA) is now a widely used treatment for cervical precancer in low- and middle-income countries. Over the past decade, TA devices have been redesigned to be more portable, user-friendly, and affordable. This analysis combines data from three large randomized clinical trials comparing the efficacy, safety, and acceptability of TA with those of the previous standard, gas-based cryotherapy. METHODS This analysis used Human Papillomavirus (HPV) test results at 1-year post-treatment as the primary outcome. Secondary outcomes included side effects and patient satisfaction. RESULTS Of the 2,948 participants treated with either TA or gas-based cryotherapy, 80.9% and 81.8% completed HPV testing at 1 year, respectively. Overall, 60.7% tested negative for HPV at follow-up, with slightly higher rates in the TA group (62.5%) compared with cryotherapy (58.7%), although the difference was not statistically significant ( P value = .14). Side effects were minimal for both treatments. Severe pain was slightly more common with TA (7.6% v 3.9% for cryotherapy), but vasovagal responses were less frequent (2.3% v 7.6%). Satisfaction with treatment was high (approximately 98%) across both groups. CONCLUSION Our findings support the efficacy of TA in treating cervical precancer, offering an effective and practical alternative in low-resource settings. However, future research is urgently needed to address critical questions, including the standardization of treatment protocols and tailored approaches for women living with HIV.