A hybrid type III effectiveness–implementation study designed to test implementation best practices of deploying a Screen-Triage-Treat approach to cervical cancer screening and management utilizing self-collected HPV DNA testing in Chokwe District, Mozambique
Abstract
Background
The current World Health Organization (WHO) recommendation for cervical cancer screening utilizing HPV DNA testing is now being endorsed by the Mozambican Ministry of Health (MOH). Initial studies showing the feasibility of screening in the Mozambican context have been encouraging, with women participants reporting a preference for self-collection approaches. A high HPV prevalence among women living with HIV/AIDS will result in a significantly higher number of women requiring follow up, many of whom can receive thermal ablation at the primary level to avoid creating bottlenecks for those who require specialized follow up. Studies designed to evaluate best practices for implementation among a high-risk, lower-resourced population within Mozambique´s already busy HIV care and treatment services are needed to provide the evidence required national scale-up this approach.
Methods
The overall aim of this study is to evaluate implementation best practices for deploying a Screen-Triage-Treat approach to cervical cancer screening and management utilizing self-collected HPV DNA testing among HIV-infected women in care within select health facilities of Chókwè District, Mozambique. The main objectives are 1) to develop an in-depth understanding of the HPV Screen-Triage-Treat care cascade within HIV care and treatment based on a collaborative, exploration-focused process with local stakeholders; 2) to evaluate the effectiveness of the Screen-Triage-Treat approach utilizing self-collected HPV DNA testing; and 3) to use the Consolidated Framework for Implementation Research (CFIR) to identify factors that explain site- and provider-level variation in the implementation of the Screen-Triage-Treat approach to cervical cancer screening and management.
Discussion
This study will contribute to the literature related to cervical cancer screening and management, and to implementation science by providing information on how screening and management can be implemented within the high-volume HIV care and treatment clinics of Mozambique. Studies that generate evidence on barriers and facilitators to the uptake of this approach, and that identify context-specific implementation strategies are important for large-scale adoption. The knowledge gained from this study will be used to assist decision makers in determining a course of action for increasing cervical cancer screening and management coverage, optimizing the intervention’s impact, and translating our findings into evidence-based programming.
Trial registration
NCT06810739 (Protocol ID: 2024–1641). Registered 04 February 2025, at https://clinicaltrials.gov/