Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

Marat Sultanov, Janine de Zeeuw, Jaap Koot, Jurjen van der Schans, Jogchum J Beltman, Marlieke de Fouw, Marek Majdan, Martin Rusnak, Naheed Nazrul, Aminur Rahman, Carolyn Nakisige, Arathi P Rao, Keerthana Prasad, Shyamala Guruvare, Regien Biesma, Marco Versluis, Geertruida H de Bock, Jelle Stekelenburg, Marat Sultanov, Janine de Zeeuw, Jaap Koot, Jurjen van der Schans, Jogchum J Beltman, Marlieke de Fouw, Marek Majdan, Martin Rusnak, Naheed Nazrul, Aminur Rahman, Carolyn Nakisige, Arathi P Rao, Keerthana Prasad, Shyamala Guruvare, Regien Biesma, Marco Versluis, Geertruida H de Bock, Jelle Stekelenburg

Abstract

Background: High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women's participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence.

Methods: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy.

Discussion: PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization's recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid.

Trial registration: ClinicalTrials.gov, NCT05234112 . Registered 10 February 2022.

Keywords: Bangladesh; Cervical cancer; Cervical cancer screening; Human papillomavirus testing; Implementation; India; Slovakia; Uganda.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Screening strategy - India and Bangladesh. * - AI-DSS in study mode only, treatment decisions will be based on manual VIA ** - Implies only absence of further testing within the project, national guidelines for screening intervals apply
Fig. 2
Fig. 2
Screening strategy - Slovak Republic. * - AI-DSS in study mode only, treatment decisions will be based on manual VIA ** - Implies only absence of further testing within the project, national guidelines for screening intervals apply
Fig. 3
Fig. 3
Screening strategy - Uganda. * - AI-DSS in study mode only, treatment decisions will be based on manual VIA ** - Implies only absence of further testing within the project, national guidelines for screening intervals apply

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