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

doi:10.1186/s12889-022-13488-z

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.

Authors

Marat Sultanov¹, Janine de Zeeuw², Jaap Koot², Jurjen van der Schans^{2

3}, Jogchum J Beltman⁴, Marlieke de Fouw⁴, Marek Majdan⁵, Martin Rusnak⁵, Naheed Nazrul⁶, Aminur Rahman⁷, Carolyn Nakisige⁸, Arathi P Rao⁹, Keerthana Prasad¹⁰, Shyamala Guruvare¹¹, Regien Biesma², Marco Versluis¹², Geertruida H de Bock^#¹³, Jelle Stekelenburg^#^{2

14}

Affiliations

¹ Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. m.sultanov@umcg.nl.
² Department of Health Sciences, Global Health Unit, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
³ Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands.
⁴ Department of Gynecology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands.
⁵ Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic.
⁶ Friendship Foundation, Dhaka, Bangladesh.
⁷ Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh.
⁸ Uganda Cancer Institute, Kampala, Uganda.
⁹ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
¹⁰ Manipal School of Information Sciences, Manipal Academy of Higher Education, Manipal, India.
¹¹ Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
¹² Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
¹³ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
¹⁴ Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, Netherlands.

^# Contributed equally.

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.

Publication types

Clinical Study
Research Support, Non-U.S. Gov't

MeSH terms

Artificial Intelligence
Early Detection of Cancer / methods
Feasibility Studies
Female
Humans
Mass Screening / methods
Papillomaviridae
Papillomavirus Infections* / diagnosis
Papillomavirus Infections* / prevention & control
Uterine Cervical Neoplasms* / diagnosis
Uterine Cervical Neoplasms* / prevention & control
World Health Organization

Associated data

ClinicalTrials.gov/NCT05234112