Prevention and Screening Towards Elimination of Cervical Cancer (PRESCRIP-TEC)

Trnavska Universita v Trnavě, Uganda Cancer Institute, International Centre for Diarrhoeal Disease Research, Bangladesh, Manipal Academy for Higher Education, Female Cancer Foundation

The research project applies the protocol of the World Health Organisation for screening of cervical cancer, with testing of hrHPV as first screening, followed by Visual Inspection of the cervix with Acetic Acid for hrHPV-positive women and for women with minor lesions thermo-ablation of affected areas. This procedure is applied in Uganda, India and Bangladesh. In Slovakia hrHPV-positive women are offered Pap-smear and for women with Pap IV lis excision.

The project performs community sensitisation and mobilisation in dedicated geographical areas and populations, to inform women and relatives about the importance of screening for cervical cancer. To eligible women self-tests for hrHPV are offered, which can be applied at home and investigated in dedicated field-laboratories. Women who are hrHPV positive are invited for further diagnosis. In Uganda, India and Bangladesh Visual Inspection of the cervix with Acetic Acid is performed. In Slovakia Pap-smear. In case dysplasia is found, further treatment is performed with cryotherapy or thermo-ablation. Cases of suspect invasive cervical cancer are referred to hospitals for diagnosis and treatment.

hrHPV test, screening cervical cancer, visual inspection cervix acetic acid, thermo-ablation, cryotherapy

In Uganda, India and Bangladesh eligible women in geographic areas are invited to perform self-test for hrHPV. hrHPV-positive women are invited for further examination of the cervix using VIA. In case of cervical dysplasia local treatment is performed. Women in vulnerable populations in Slovakia are invited to self-test for hrHPV. hrHPV positive women are seen by gynaecologist for Pap-smear cytology. Based on classification further therapy is offered

use of social media, written media, theatre and other sources of communication to reach women, and relatives, to convince them of importance of screening.

use of swabs that women insert in the vagina for taking sufficient material for testing for hrHPV. For women who are not confident to perform this this nurses provide assistance.

based on the results of the test, follow-up is offered. In case of hrHPV negative test, retesting after five years. In case of hrHPV positive test, VIA in a nearby clinic. Women have to be motivated to adhere to follow-up

Women with identified dysplasia lesions are offered immediate therapy to remove the infected superficial surface of the cervix

Cytology for identification of abnormal cells in the cervix, and classification of stages of dysplasia or pre-cancerous lesions

Percentage of eligible women who take self-test out of women who have been offered self-test for hrHPV

Percentage of women who take self-test out of women in geographical area eligible for self-test for hrHPV.

18 months between start approaching women in geographical area and closing screening operations in that area

Percentage of women who are hrHPV-positive and are invited for VIA or Pap-smear who actually undergo the procedure

One month between communicating hrHPV test result and measuring attendance in clinic for VIA or Pap-smear

Percentage of health facilities involved in the research that is capable of performing the screening protocol fully (both human resources capacity as equipment and supplies

24 months between start of preparations of health facilities for cervical cancer screening and measuring capabilities of health facility

Percentage of local, district, regional health organisations involved in the study, that is able to maintain the screening protocol as Integrated part of service delivery

24 months between start of preparations in geographical area and measuring cervical cancer screening policies and practices in organisation

Level of unit cost per screening following the new protocol and affordability in low and middle income countries

Inclusion Criteria: Female in eligible age group Ability to give informed consent and participate in study Exclusion Criteria: Clinical signs of cervical carcinoma Menstruation or other vaginal blood loss

Sultanov M, Zeeuw J, Koot J, der Schans JV, Beltman JJ, Fouw M, Majdan M, Rusnak M, Nazrul N, Rahman A, Nakisige C, Rao AP, Prasad K, Guruvare S, Biesma R, Versluis M, de Bock GH, Stekelenburg J. 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). BMC Public Health. 2022 Jul 15;22(1):1356. doi: 10.1186/s12889-022-13488-z.