Characteristics of stakeholders interviewed.

Cervical cancer is preventable, yet it remains the fourth most common cancer in women globally. The highest incidence and mortality occur in low- and middle-income countries (LMICs), where over 70% of women have never been screened, and 58% of the cases are in Asia. While the COVID-19 pandemic caused significant disruptions to cervical screening programs, particularly for LMICs, there were opportunities that emerged from the pandemic that were enablers of program recovery. Stakeholders played key roles in materialising strategy into implementation. Therefore, in this study, we examined the barriers and facilitators to implementing recovery strategies from the stakeholders’ perspectives. We interviewed fifteen stakeholders from nine LMICs in the Asia-Pacific region directly involved in the implementation of the cervical screening program. A total of 23 barriers and 21 facilitators were identified, of which seven barriers and nine facilitators related directly to the pandemic. Pandemic-related barriers included movement restrictions, resource diversion, cancelled campaigns and training, deprioritisation of HPV prevention efforts, and a reduced health workforce. Stakeholders concurred that most barriers had predated the pandemic and remained as the pandemic eased. Conversely, the pandemic introduced facilitators such as means for targeted campaigns, improved understanding of viruses, accessible training with online platforms, better PCR testing capabilities, a shift in the government’s position towards preventive health services, and openness to HPV testing and self-swabs. The emerging facilitators offered opportunities to address some of the persistent barriers, such as limited cervical cancer awareness and insufficient healthcare providers in screening programs. However, effective implementation of these emerging facilitators requires improved communication and collaboration between policymakers and implementers to accelerate the recovery of screening programs in LMICs. Further work is necessary to align emerging facilitators with the health system goals and resource settings of each country in turning these opportunities into actions.

宫颈癌是可预防的恶性肿瘤，但仍是全球女性群体中第四大高发癌症。其发病率与死亡率的峰值均出现在中低收入国家（Low- and Middle-Income Countries, LMICs），该地区超过70%的女性从未接受过宫颈癌筛查，且全球58%的宫颈癌病例集中于亚洲。尽管COVID-19疫情对宫颈癌筛查项目造成了显著冲击，对中低收入国家的影响尤为深重，但疫情同时催生了助力项目复苏的机遇。利益相关方在将战略规划落地实施的过程中发挥了核心作用。因此，本研究从利益相关方视角出发，调研了宫颈癌筛查项目复苏策略实施过程中的阻碍因素与促进因素。研究团队访谈了亚太地区9个中低收入国家的15名直接参与宫颈癌筛查项目落地的利益相关方，最终共识别出23项阻碍因素与21项促进因素，其中7项阻碍因素与9项促进因素与COVID-19疫情直接相关。与疫情相关的阻碍因素包括：出行限制、医疗资源分流、筛查活动与培训计划取消、人乳头瘤病毒（Human Papillomavirus, HPV）预防工作被置于次要优先级、医疗卫生人力规模缩减。利益相关方一致认为，多数阻碍因素早在疫情爆发前就已存在，且在疫情缓和后依然存续。与之相对，疫情催生了一系列促进因素：包括定向筛查活动的实施路径、病毒认知水平的提升、依托在线平台开展的便捷培训、聚合酶链反应（Polymerase Chain Reaction, PCR）检测能力的增强、政府对预防型医疗服务的态度转变，以及对HPV检测与自我采样拭子的接受度提升。这些新兴促进因素为解决部分长期存在的阻碍问题提供了契机，例如宫颈癌认知度不足、筛查项目中医护人力短缺等。但要有效落地这些新兴促进因素，仍需政策制定者与项目实施者加强沟通协作，以加快中低收入国家宫颈癌筛查项目的复苏进程。此外，还需开展进一步研究，将新兴促进因素与各国的卫生系统目标及资源配置相适配，从而将这些机遇转化为实际行动。