Grant: Master's Award: Canada Graduate Scholarships

Cervical cancer is the leading cause of cancer mortality among women in Tanzania, with 9770 new cases and 6995 deaths annually. It is primarily caused by human papillomavirus (HPV), a sexually transmitted infection. While the national screening guideline for cervical cancer is to use visual inspection with acetic acid (VIA), its low accuracy and diagnostic subjectivity raises concerns. Instead, the World Health Organization recommends HPV DNA self-sampling of cervical cells as the primary screening method. Despite the available screening options, loss to follow-up among HPV+ women pose a major challenge in cancer management, further contributing to the high mortality rates. This study will investigate the most cost-effective screening strategy that can accurately diagnose patients and will integrate the use of patient navigation (PN) to address the loss to follow-up. We aim to compare HPV DNA self-sampling with automated visual evaluation (HPV-AVE) as a diagnostic tool to VIA and use individual or combination PN strategies for cancer management. We hypothesize that HPV-AVE is more cost-effective than VIA, and PN in combination with technology and healthcare workers reduces loss to follow-up. 5000 women aged 30-49 in Kilimanjaro, Tanzania will be recruited to conduct an HPV DNA self-sampling and HPV+ individuals will be randomized into one of four PN arms to be encouraged for precancerous screening. An economic analysis will be conducted across four health facilities to compare the affordability between HPV-AVE and VIA by collecting costing data and accounting for patients time and resources. These findings will provide critical guidance for high-level stakeholders to modify existing screening guidelines that will minimize costs and optimize patient prognosis.