Research Project 2

Cervical cancer is the leading cause of cancer-related deaths among people in low and middle-income countries (LMICs) and a key contributor to global variation in cancer incidence and mortality. The WHO recommends Human Papillomavirus (HPV)-based testing followed by immediate treatment, known as screen-and-treat (SAT). Although endorsed in global and national guidelines, the SAT approach has not yet been widely implemented outside of research settings. New technologies such as the Xpert HPV DNA test, a point-of-care (POC) test which has distinct advantages over competing assays and has been shown to be cost-effective in low-resource settings, is also more expensive. Like many countries, South Africa is grappling with how to operationalize and promote the widespread uptake of HPV-based screening. Through a 30-year collaboration between investigators at Columbia University and the University of Cape Town, and leveraging Project 1’s development and evaluation of strategies for the implementation and evaluation of Xpert HPV POC-SAT, this Project 2 of the Empilisweni Initiative will address the cost and financing of POC-SAT and its tailored implementation strategies. In Aim 1, using a comprehensive tool from the WHO, we will estimate costs of cervical cancer screening pre and post implementation of HPV-based POC-SAT in public primary care settings in Khayelitsha. Outcomes will be cost per person screened and cost per person screened and treated. In Aim 2, we will conduct a time-and-motion study to estimate the costs of the scalable, tailored implementation strategy package to support delivery of POC-SAT in two primary care facilities implementing Aim 3 of Project 1. In Aim 3, we will use a fiscal mapping process to identify, select, and pursue innovative financing strategies for HPV-based SAT and its implementation in Western Cape. Cost data collection will be conducted in coordination with the Capacity Building and Stakeholder Engagement Cores to translate knowledge needs and study findings, where applicable. We will further synergize activities by leveraging the routine Administrative and Engagement Core stakeholder meetings and External Advisory Panel to brief stakeholders before and after cost data collection, analysis, and reporting. The findings of this project will be disseminated to local and regional stakeholders to aid decision-making regarding investments in cervical cancer screening and advance the widespread use of HPV-based SAT in South Africa.