Study Participants.

Proyecto Precancer is an implementation science and systems-thinking project with the objective of facilitating the adoption of a new screen-and-treat intervention for cervical cancer prevention in Iquitos in the Peruvian Amazon basin. This intervention introduced human papillomavirus molecular testing and shifted treatment from the tertiary level to the primary level through visual assessment for treatment and thermal ablation for those eligible. To inform how we scale up this pilot project to new regions in Peru in collaboration with the Ministry of Health, we conducted this realist evaluation to learn what worked in our pilot intervention in Iquitos, in what circumstances, for whom, and why. We developed four initial program theories, tested them through interviews with 32 stakeholders, we refined the four program theories based on the interviews, and added a fifth theory. This evaluation revealed that continuous engagement with providers in a horizontal manner across the systems’ professional hierarchies (Program Theories 1, 4, and 5) and centering patients with a more convenient and accessible continuum of care can, ultimately, lead to improved screening and treatment rates and reduced patient loss to follow-up (Theories 2 and 3). Furthermore, we learned from our collaborators that embedded research within the public health system had high potential for sustainability due to local ownership. These insights will inform our work as this project assists the Ministry of Health in adapting and scaling up the intervention in other parts of Peru.

癌前病变项目（Proyecto Precancer）是一项实施科学与系统思维研究项目，旨在推动秘鲁亚马逊流域伊基托斯地区宫颈癌预防新型「筛查-治疗」一体化干预方案的落地应用。该干预方案引入人乳头瘤病毒（human papillomavirus，HPV）分子检测技术，并将治疗环节从三级医疗机构下移至基层医疗机构：通过可视化评估筛选符合治疗指征的人群，并采用热消融术实施治疗。为助力本试点项目与秘鲁卫生部合作推广至秘鲁其他地区，我们开展了本次实在论评价（realist evaluation），以探究伊基托斯试点干预方案的有效实施场景、适配人群及背后的作用机制。我们初步构建了四项项目理论，并通过对32名利益相关者（stakeholder）的访谈对其进行验证，随后基于访谈结果修订了这四项理论，并新增第五项理论。本次评价结果显示，以跨系统专业层级的扁平化协作方式持续对接医疗机构从业者（对应项目理论1、4与5），以及以更便捷可及的连续照护为中心聚焦患者需求（对应项目理论2与3），最终可提升筛查与治疗覆盖率，降低患者失访率。此外，我们从合作方处了解到，嵌入公共卫生系统内的研究因具备本土主导性，拥有极高的可持续发展潜力。上述研究成果将为后续工作提供重要参考，助力本项目协助秘鲁卫生部在秘鲁其他地区适配并推广该干预方案。