Background - The burden of cervical cancer is unequally distributed globally, with over
90% of deaths occurring in low- and middle-income countries (LMICs), mainly due to
insufficient uptake of preventive measures such as screening. In 2020, the World Health
Organization launched a global initiative for the worldwide elimination of cervical
cancer as a public health issue, setting a target of 70% of women screened with a
high-performance test. In Cameroon, this target is far from being reached, and rural
communities are disproportionately affected by low uptake of screening services.
Recently, a new cervical cancer screening program has launched in the Bafoussam Regional
Hospital, in the capital of the Mifi Health District, as part of a larger research
project. To develop a context-specific strategy improving access to screening for women
living in rural areas of the district, the active participation of community members for
the co-development and implementation of local strategies for cervical cancer screening
may be key to improving population screening coverage.
Objective - The aim of this study is to evaluate the use of community co-produced action
(CCA) for the development and implementation of HPV-based cervical cancer screening
strategies compared to a traditional hospital-based approach in rural areas of the Mifi
Health District in Cameroon.
Methods - Using a cluster-randomized study design, participatory workshops with community
members will be led in 7 rural health areas assigned to the intervention arm, with the
aim of codeveloping local strategies for HPV-based cervical cancer screening adapted to
the setting. The co-produced strategies may include raising awareness among eligible
women (aged 30-49 years, or 25-49 years if HIV-positive), as well as facilitating access
to screening tests, results and follow-up. Women living in one of the 7 health areas
assigned to the control arm will be invited by community health workers to undergo
screening at the Bafoussam Regional Hospital. In both study arms, screened women will be
included in the GENOVA study, a cervical cancer screening trial offering free-of- charge
HPV testing followed by triage by visual inspection or genotyping for HPV-positive women,
and free treatment according to triage results. CCA will be evaluated by assessing its
effectiveness for screening uptake. Screening coverage among eligible women will be
estimated during one year after implementation of screening strategies in both study
arms, based on population statistics provided by the Mifi health district for each health
area.
Expected results - Developing context-sensitive solutions to cervical cancer screening
through a community-based participatory approach in rural areas of the Mifi health
district is expected to improve screening participation rate.
