Acting on the call for cervical cancer elimination: Planning tools for low- and middle- income countries to increase the coverage and effectiveness of screening and treatment

Table 4 Relative comparison of tradeoffs across cervical cancer screening approaches for low- and middle-income countries included in the Cervical Precancer Planning Tool (CPPT)

		Benefits				Potential challenges
Screening approach	Description and pathway to treatment	Screening coverage for a fixed cost	Minimum clinic visits for screening	Option for self-sampling	Option for same-day treatment	Cases missed^a	Overtreatment
VIA alone	A woman is screened with VIA (regular or enhanced). If positive, she is referred directly to treatment	Lowest	1^b	No	Yes	High (will vary by provider)	High (will vary by provider)
HPV alone^e	A woman is screened with an HPV test. If positive, she is referred to treatment without triage	Moderate	0^c–1	Yes	Only with point of care HPV testing^d	Lowest	Highest
HPV and VIA triage	A woman is screened with an HPV test. If positive, she is referred to a VIA triage test. If the triage test is positive, she is referred to treatment	Moderate	1^c–2	Yes	Only with point of care HPV testing^d	Highest	Low
HPV and enhanced triage^f	Same as HPV & VIA triage, but the triage test is an enhanced/higher-quality test.^f	Highest^f	1^c–2	Yes		Moderate	Lowest

^aMay be the most important metric if considering screening once in a lifetime
^bAssuming treatment is available on-site the day screening result is given to woman
^cAssumes HPV testing could be done with self-sampling
^dPoint of care diagnostic is typically defined as results within 15 min to 2 h (See further for the REASSURED criteria) [18]
^eMeets WHO definition of “high-precision” [4]
^fEnhanced triage options currently under evaluation; CPPT tool assumes enhanced triage should lead to a sensitivity and specificity of at least 80%, and/or an improvement of 20% over the baseline triage approach (VIA)

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