Turnaround Time Trends in Cervical Cytology Screening in South Africa, 2005–2023

Abstract

BACKGROUND: Timely cervical cytology results are crucial for effective screening and early management of precancerous lesions. However, many low- and middle-income countries face delays in turnaround time (TAT). This study assessed TAT for cytology screening results in South Africa from 2005 to 2023 and identified factors associated with TAT delays. METHODS: We conducted a cross-sectional analysis of public health routine program data from the National Health Laboratory Service for women aged ≥ 15 years. We defined TAT as the time from sample collection to the release of results. The recommended TAT benchmark is 14 days; we defined delays as TAT exceeding 14 days. We used descriptive statistics and multivariable logistic regression to assess TAT trends and factors associated with delays. RESULTS: From 2005 to 2023, 12,246,041 cervical cytology smears were processed. The median age at screening was 38.8 years (IQR: 31.0-41.1), ranging from 15 to 95 years. Median TAT consistently exceeded 14 days, peaking at 25 days between 2014 and 2019. Delays were significantly associated with location, with higher odds in self-sufficient (aOR 2.33; 95% CI: 2.32-2.34) and laboratory-dependent regions (aOR 1.61; 95% CI: 1.61-1.62). Samples processed in referral laboratories had higher odds of delay (aOR 4.08; 95% CI: 4.07-4.10). Seasonal variation also affected TAT delays, with higher odds observed in the third quarter (aOR 1.40; 95% CI: 1.39-1.40) as compared to the first quarter. CONCLUSION: Throughout South Africa, cervical cytology TAT remains above the recommended benchmarks. Delays are driven by structural and operational factors. Strengthening laboratory capacity, optimizing workflows, and transitioning to organized screening programs are critical for timely results and improved cervical cancer prevention outcomes.