The Empilisweni Initiative - Advancing Implementation of Cervical Cancer Control - Cervical cancer is a leading cause of cancer-related deaths among individuals in low- and middle-income countries (LMICs), and it is almost entirely preventable.1,2-4 In 2020, the World Health Organization (WHO) announced a global strategy to accelerate the elimination of cervical by the end of this millennium through a two-pronged primary and secondary prevention strategy of vaccinating 90% of young people aged 9-15 years and screening 70% of individuals and treating 90% of treatment eligible people by 2030 and sustaining those levels.5 Based on strong empirical evidence of effectiveness and safety, the WHO recommends Human Papillomavirus (HPV)-based testing followed by immediate treatment of pre-cancerous lesions, an approach called screen-and-treat (SAT) for achieving cervical cancer control in LMICs.6 Our investigator team at Columbia University Irving Medical Center (CUIM) and the University of Cape Town (UCT), through a nearly thirty-year collaboration under the Khayelitsha Cervical Cancer Screening Program (KCCP), have conducted seminal clinical trials demonstrating the safety and effectiveness of HPV-based screening and treatment.7-9 Although endorsed in global and national guidelines, the SAT approach has not yet been widely implemented. Like most LMICs, South Africa is grappling with how to operationalize and promote the widespread and integration and uptake of HPV screening in healthcare settings. Stakeholders cite a lack of context-specific implementation, costs, and financing as important implementation barriers. Aligned with RFA-CA-22-019 and in partnership between the KCCP and the Western Cape Department of Health (WCDoH), we propose the Empilisweni (isiXhosa for a place of healing) Initiative with the overarching mission to accelerate the integration and scale-up of evidence-based interventions for global cervical cancer elimination among individuals in resource-constrained settings. Led by MPIs; Denny (UCT), and Kuhn (CUIMC), who founded KCCSP, will be joined by MPI Castor (Contact: CUIMC), Mbatani (UCT), Saidu (UCT), Shelton (CUIMC), Tehranifar (CUIMC); and Arendse (UCT/WCDoH) and collaborator Cloete (WCDoH) Informed by implementation science frameworks and stakeholder engagement approaches, we propose to: Aim 1: Support the WHO’s global strategy to accelerate the elimination of cervical cancer by the end of this millennium by integrating scalable, affordable HPV-based point-of-care screen-and-treat (POC-SAT) strategies to achieve the secondary prevention cascade goal of 70% screening and 90% treatment of individuals who screen positive by 2030 in the Western Cape Province of South Africa; and Aim 2. Catalyze integration and sustainable scale-up of POC-SAT by fostering effective collaboration, coordination, capacity-building, and knowledge sharing across multiple key stakeholders. By the end of the five years, POC SAT will increase the proportion of people who are screened and treated regionally, will complement centralized HPV testing, and be economically feasible. We will have a strengthened capacity for leading implementation research in the region and advanced work on strategies to inform scalable delivery and innovative financing of cervical cancer control for population-level impact.
