Foumbot

Cervical cancer is a major cause of death among women living with HIV, especially in resource-limited areas. This research compares two methods of cervical cancer screening a centralized approach using well-equipped centers, and a decentralized approach using a mobile team that brings equipment and staff to patient care locations. The study aims to find the most effective strategy for screening and treatment to inform national health decisions. The study involves a stepped-wedge design where all sites start with the centralized screening method. Over six periods of 10 weeks each, sites gradually switch to the decentralized mobile team strategy. In the centralized group, women provide a self-collected vaginal sample sent to a lab, and those testing positive travel to a reference center for further examination and treatment if needed. The mobile team visits health centers regularly to perform HPV testing and treatment on-site. Participants are women living with HIV, aged 25 to 49, eligible for cervical cancer screening and receiving or starting antiretroviral therapy. They will be followed to assess screening completion within 120 days after enrollment. The study includes questionnaires and evaluations on the acceptability, feasibility, and quality of each screening approach. Additional measures include the performance of urine HPV tests, methods to identify women needing treatment, and monitoring cervical health 12 months after treatment.