From Pap Test to Treatment: Assessing Facility Level Gaps in Cervical Cancer Care in Cape Town.

Introduction: The World Health Organization (WHO) 90‑70‑90 cervical cancer elimination targets aim for 90% human papillomavirus (HPV) vaccination rates, 70% cervical screening rates, and 90% treatment rates for women with cervical disease. Although progress has been made in vaccination and screening in South Africa, less is known about treatment coverage following abnormal screening results. We focused on adherence to colposcopy clinic referrals among women with abnormal cytology. Methods: We conducted a retrospective descriptive study of cervical cytology samples collected in 2022 from women attending 19 public healthcare facilities within a sub‑district of Cape Town. All cytology results reported as high‑grade intraepithelial lesions or invasive cervical carcinoma (HSIL+) were included. Colposcopy clinic attendance was defined as documented histological sampling within 24 months of diagnosis. Colposcopy clinic attendance rates (CCARs), test time intervals, and distance from referral hospital were calculated for each facility. Facilities were compared using percentile distributions, and distance to referral hospitals was analyzed as a potential spatial barrier. Results: Of 9,069 cervical samples, 556 (6.1%) were reported as HSIL+. Overall, 65.8% of women underwent histological sampling within 24 months. CCARs varied across facilities, ranging from 42.5% to 87.5% (mean 63.1%). Distance to referral hospitals (range 0-22 km; mean 10.8 km) showed no correlation with colposcopy clinic attendance. Conclusion: A substantial gap exists between current CCARs and the WHO treatment target. Variability among facilities, independent of geographic distance, suggests that health system factors, such as communication, recall, and referral processes, play a key role in treatment outcomes.