Assessing the Capacity of Health Facilities to Deliver Concomitant HPV Vaccination and HPV-Based Cervical Screening Services to Vulnerable Populations - An Implementation Research Protocol.

IntroductionIn Europe, cervical cancer (CC) is the third most common gynaecologic cancer, and the second among women under the age of 45. CC screening uptake is highly variable across the region, and especially low among vulnerable groups.Current evidence suggests that HPV (Human Papilloma Virus) vaccination benefits women beyond traditional adolescent vaccination age groups, and so the HPV-FASTER approach has been proposed as a strategy to accelerate the elimination of CC in Europe. The HPV-FASTER-Implement implementation research project aims to evaluate strategies that integrate HPV-based screening with concomitant HPV vaccination (HPV-FASTER approach) for vulnerable groups aged 25-45 years, including migrants and sex workers in Spain and Sweden, women living with HIV and transgender men in Denmark, incarcerated women in Romania, and women living in deprived areas in France.MethodsTo assess the capacity of health systems to deliver combined HPV vaccination and HPV-based screening, we adapted the Cervical Cancer Screening Service Availability and Readiness Assessment (CervScreen-SARA) protocol and tools, considering also the WHO Effective Vaccine Management tool. This implementation research protocol includes three components: a desk review of CC screening and vaccination guidelines, and policies currently in place; screening, colposcopy, and vaccination services facility visits; and interviews with key meso- and macro-level stakeholders. Triangulation of the information allows the identification of strengths and areas of improvement in implementing the HPV-FASTER approach.ConclusionsThis implementation research protocol offers a structured approach to assess the readiness of health systems to deliver combined HPV vaccination and HPV-based CC screening to vulnerable populations, and will allow the tailoring of strategies to strengthen CC prevention services.