review · PLOS Global Public Health
Cervical cancer is a leading cause of death among women in low- and middle-income countries. A scoping review of 28 original studies published between 2000 and 2023 mapped evidence on integrating cervical cancer screening into existing primary care facilities across these regions. The findings show that 39 percent of the evaluated programmes incorporated screening into HIV clinics. Other common settings included reproductive and sexual health clinics, maternal and child health centres, family planning units, well-baby clinics, and gynaecology outpatient departments. Key drivers facilitating integration included cost-effectiveness, promotional efforts, and international initiatives. Conversely, significant operational obstacles included resource scarcity, shortage of skilled staff, high client workloads, prolonged waiting times, lack of national guidelines or preventive oncology policies, territorial disputes, and poor coordination. Overcoming these health system constraints is essential to successfully integrate screening and improve prevention and treatment outcomes.
Most deaths from cervical cancer happen in low- and middle-income countries where access to dedicated cancer services is scarce. Linking screening to routine primary care services like maternal health and HIV clinics helps reach vulnerable women early. Identifying the operational barriers and facilitators allows healthcare planners to design better integrated services, ultimately catching disease sooner and saving lives.
The abstract does not indicate an application pathway or a direct commercialisation angle, focusing instead on public health service delivery and policy implementation.
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Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.
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DOI: 10.1371/journal.pgph.0003183
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