Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.

The World Health Organization (WHO) announced an ambitious call for global cervical cancer elimination within the next century. More than 80% of cervical cancers occur in low-and-middle-income countries (LMICs), where the age-standardized mortality rates are six-times higher than in high-income countries. The goal of this dissertation is to outline a roadmap toward cervical cancer elimination in LMICs and evaluate a community-based HPV self-sampling program in Peru via micro-costing and mixed-method study of empowerment. In the first aim, we conduct a scoping review to synthesize evidence-based primary and secondary prevention strategies for cervical cancer and highlight research gaps and priorities. We find that effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing and thermocoagulation, and discuss implementation challenges in LMICs. Aims 2 and 3 are nested within a community-based HPV self-sampling social entrepreneurship in Peru called the Hope Project, where volunteer women (Hope Ladies) from socioeconomically disadvantaged peri-urban area of Lima sell HPV self-sampling kits in their communities to increase cervical cancer screening coverage. In Aim 2, we conduct a micro-costing analysis from the program perspective to determine the unit costs of: (1) recruitment and training of Hope Ladies, (2) Hope Ladies distributing HPV self-sampling kits (careHPV), and (3) Hope Ladies linking screened women with appropriate follow-up care. We find that community-based HPV self-sampling appears to be a feasible way to improve cervical cancer screening in Peru. In Aim 3, we evaluate the Hope Ladies' individual and collective relational and financial empowerment after participating in the Hope Project. We use deductive content analysis and surveys informed by empowerment frameworks (e.g., Kabeer's conceptual model) to triangulate our qualitative and quantitative findings. We develop an implementation-science informed causal pathway for the Hope Project, where the Hope Ladies' financial/relational empowerment function as the mechanism of action for this intervention and articulate the pre-conditions necessary to increase the screening coverage. Finally, we conclude that cervical cancer elimination in LMICs would require intersectoral collaboration to increase access to and coverage of evidence-based strategies. We call for implementation, scale-up and economic and programmatic evaluation of community-based HPV self-sampling in LMICs.

Cervical Cancer is the fourth most common cancer among women, worldwide. It accounts for 600,000 new cases per year, and 340,000 deaths globally (WHO 2020 data). It causes a lot of maladies and suffering for women, in the age group of 30,Äì60 years, especially in the poor community of developing countries. Cervical cancer is a great public health problem and is a cause of grave concern for the health system in Low-Middle-Income Countries,ÄîLMIC. But cervical cancer is amenable for early detection and successful treatment of precancer stages. Human Papilloma Virus,ÄîHPV vaccines offer a high level of primordial prevention, against cervical cancer. Therefore, the World Health Organization, in 2018, has called for ,ÄúElimination of Cervical Cancer by 2030.,Äù The objective is to reduce the incidence rate of cervical cancer to below 4/100,000, by the year 2030. This leads to many ,ÄúNeo Challenges,Äù and also opens the door for ,ÄúNext Gen Solutions,Äù. The author, with vast experiences in his Cervical Cancer Screening Projects of IARC/ WHO, at Tamil Nadu, India, during 2000,Äì2007, advocates a strategy called ,ÄúTIT for TAT,ÄîThe Community Competency model of Raj¬©.,Äù.

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Cancer Care: Assuring Quality to Improve Survival surveys the policy trends in cancer care over recent years and looks at survival rates to identify the why some countries are doing better than others.