Journal Article

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

Nicula, Florian, Mosquera, Isabel, Baban, Adriana, Lunet, Nuno, Basu, Partha, Tisler, Anna, Mensah, Keitly, Uusküla, Anneli, Firmino-Machado, João, Tăut, Diana

2024

Overview

Background Cervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings. Methods Our research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants’ interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context. Results Conducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions. Conclusions Our study’s novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Cancer / Cancer screening / Cancer therapies / Capacity assessment / Capacity Building / Cellular biology / Cervical cancer / Collaboration / Colposcopy / Context / Contextual analysis / Delivery of Health Care / Diagnosis / Early Detection of Cancer - methods / Europe / Evaluation / Feasibility / Feasibility studies / Female / Health Administration / Health care / Health care industry / Health care policy / Health facilities / Health Policy / Health services / Health Services Research / Heterogeneity / Human papillomavirus / Humans / Implementation / Infrastructure / Intervention / Interviews / Laboratories / Mass Screening / Medical policy / Medical screening / Medicine / Medicine & Public Health / Oncology, Experimental / Papillomaviridae / Papillomavirus Infections - diagnosis / Pilot Projects / Portugal / Protocol / Public Health / Questionnaires / R & D/Technology Policy / Resources / Respondents / Romania / Screening / Stakeholders / Surveys / Tests / Threat evaluation / Underserved populations / Uterine Cervical Neoplasms - diagnosis / Uterine Cervical Neoplasms - prevention & control / Women / Womens health