World Health Organization, Geneva, Switzerland.
Consultant for the US National Cancer Institute, MD, USA.
Prev Med. 2022 Feb;155:106906. doi: 10.1016/j.ypmed.2021.106906. Epub 2021 Dec 8.
Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem.
New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts.
For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.
宫颈癌是一个重大的公共卫生问题，每年有 57 万新发病例和 30 万女性死亡，主要发生在中低收入国家。2018 年，世卫组织总干事呼吁采取行动，消除宫颈癌这一公共卫生问题。
需要新的思路来制定方案，以便在大规模范围内采用新兴技术和筛查及治疗宫颈癌前病变的干预措施，从而实现消除目标。实施研究（IR）是促进基于证据的筛查和治疗干预措施扩大规模的一个重要但未被充分利用的工具，因为大多数研究都集中在开发和评估新的干预措施上。现在是各国确定其具体实施研究需求的时候了，以了解干预措施的可接受性、可行性和成本效益，从而设计和确保基于证据的筛查和治疗干预措施的有效实施、扩大规模和可持续性。世卫组织召集了一个专家咨询小组，以确定基于 HPV 的筛查和治疗干预措施在基于人群的方案中的优先实施研究问题。一些国际组织正在支持许多国家大规模引入筛查和治疗方法，为在不同的国家背景下评估不同的方法和策略提供了理想的平台。
为了降低宫颈癌的发病率和死亡率，需要更好地了解卫生系统的准备情况、新技术和算法在提高筛查和治疗覆盖率方面的可及性和有效性，以及支持这些方案可持续性的因素。回答这些关键的实施研究问题可以为寻求实施世卫组织全球消除宫颈癌战略的国家提供可行的指导。
