ArticlePreventive medicine2021
Achieving equity in cervical cancer screening in low- and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach.
Article in Preventive medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 64 citations in OpenAlex.
- Cervical cancer screening policy inequality worldwide: a systematic review of disparities in access and implementation.Journal of translational medicine · 2026Pooled it
- Pooled it
- Community-integrated self-collected HPV-based cervix screening in a low-resource rural setting: a pragmatic, cluster-randomized trial.Nature medicine · 2023Trial
- Real-World Performance of HPV DNA-Based Screening in Health Resource-Limited Areas of China: A Multicenter Implementation Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026Article
- Review
- Health Equity Barriers to Accessing Vaccination and Screening Services in Low- and Middle-Income Countries: A Narrative Review.Risk management and healthcare policy · 2026Review
- Linkage to and retention in chronic care among patients diagnosed with hypertension, diabetes, or HIV in DIMAMO PHRC clinics, South Africa.PLOS global public health · 2026Article
- Advancing implementation of shared care for cancer survivors using a systems thinking approach (the SEAMLESS study).Journal of cancer survivorship : research and practice · 2025Article
- Low participation in cancer screening in India: a scoping review of breast and cervical cancer programs.BMC cancer · 2025Article
- [Global disease burden of cervical cancer and the association of screening coverage with quality of disease management].Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences · 2025Article
- Advancing Cervical Cancer Prevention Equity: Innovations in Self-Sampling and Digital Health Technologies Across Healthcare Settings.Diagnostics (Basel, Switzerland) · 2025Review
- Identifying Data-Driven Clinical Subgroups for Cervical Cancer Prevention With Machine Learning: Population-Based, External, and Diagnostic Validation Study.JMIR public health and surveillance · 2025Article
- Early evaluation of a screen-and-treat strategy using high-risk HPV testing for Uganda: Implications for screening coverage and treatment.Journal of global health · 2024Article
- Implementation of WHO guidelines for cervical cancer screening, diagnosis and treatment: knowledge and perceptions of health providers from Argentina.BMC cancer · 2024Article
- Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination.Nature reviews. Clinical oncology · 2024Review
- Prevalence and trends of cervical cancer screening among women in Fiji from 2014 to 2018.Heliyon · 2024Article
- Implementation of new technologies designed to improve cervical cancer screening and completion of care in low-resource settings: a case study from the Proyecto Precancer.Implementation science communications · 2024Article
- From barriers to opportunities from COVID-19 pandemic: Stakeholder perspectives on cervical cancer screening programs in LMICs of the Asia-Pacific region.PLOS global public health · 2024Article
- "Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.BMC public health · 2023Article
- Prevalence and sociodemographic predictors of high-risk vaginal human papillomavirus infection: findings from a public cervical cancer screening registry.BMC public health · 2023Article
Corrections and comments
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Authors and funding
12 authors at 10 institutions in 5 countries.
Funding
Abstract
The World Health Organization (WHO) is leading a call to action to eliminate cervical cancer by the end of the century through global implementation of two effective evidence-based preventive interventions: HPV vaccination and cervical screening and management (CSM). Models estimate that without intervention, over the next 50 years 12.2 million new cases of cervical cancer will occur, nearly 60% of which are preventable only through CSM. Given that more than 80% of the cervical cancer occurs in low- and middle-income countries (LMICs), scaling up sustainable CSM programs in these countries is a top priority for achieving the global elimination goals. Multiple technologies have been developed and validated to meet this need. Now it is critical to identify strategies to implement these technologies into complex, adaptive health care delivery systems. As part of the coordinated cervical cancer elimination effort, we applied a systems thinking lens to reflect on our experiences with implementation of HPV-based CSM programs using the WHO health systems framework. While many common health system barriers were identified, the effectiveness of implementation strategies to address them was context dependent; often reflecting differences in stakeholder's belief in the quality of the evidence supporting a CSM algorithm, the appropriateness of the evidence and algorithm to context, and the 'implementability' of the algorithm under realistic assessments of resource availability and constraints. A structured planning process, with early and broad stakeholder engagement, will ensure that shared-decisions in CSM implementation are appropriately aligned with the culture, values, and resource realities of the setting.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.