Bandjoun

Cervical cancer is a major cause of death among women living with HIV in areas with limited resources. Effective screening and prevention methods exist, involving multiple steps like HPV testing, visual inspection, and treatment when needed. This research evaluates two different ways to provide cervical cancer screening to women living with HIV: a centralized approach at well-equipped centers and a decentralized approach using a mobile team visiting usual patient care locations. The study also includes sub-studies on urinary HPV testing, identifying women needing treatment, and risks after treatment. The study compares the centralized strategy, where samples are sent to a reference lab and positive women visit a center for triage and treatment, with the decentralized strategy, where a mobile team performs HPV testing and immediate triage with treatment at health centers. The mobile team includes midwives and a lab technician using a Genexpert platform for point-of-care HPV testing. The trial is organized into six periods of 10 weeks each, with sites switching from centralized to decentralized screening. The main goal is to measure screening completeness within 120 days after enrollment. Participants are women living with HIV aged 25 to 49 who are eligible for cervical cancer screening and receiving or starting antiretroviral treatment. They will provide vaginal self-samples and may undergo triage and treatment if HPV positive. The study monitors the success, reach, and acceptability of each screening approach from both patients' and healthcare workers' perspectives. Outcomes include screening completeness, performance of different HPV testing methods, and treatment effectiveness. The total participation time involves evaluation during the screening process and follow-up within 120 days after enrollment.