Table_1_A Framework for Cervical Cancer Elimination in Low-and-Middle-Income Countries: A Scoping Review and Roadmap for Interventions and Research Priorities.docx

The World Health Organization announced an ambitious call for cervical cancer elimination worldwide. With existing prevention and treatment modalities, cervical cancer elimination is now within reach for high-income countries. Despite limited financing and capacity constraints in low-and-middle-income countries (LMICs), prevention and control efforts can be supported through integrated services and new technologies. We conducted this scoping review to outline a roadmap toward cervical cancer elimination in LMICs and highlight evidence-based interventions and research priorities to accelerate cervical cancer elimination. We reviewed and synthesized literature from 2010 to 2020 on primary and secondary cervical cancer prevention strategies. In addition, we conducted expert interviews with gynecologic and infectious disease providers, researchers, and LMIC health officials. Using these data, we developed a logic model to summarize the current state of science and identified evidence gaps and priority research questions for each prevention strategy. The logic model for cervical cancer elimination maps the needs for improved collaboration between policy makers, production and supply, healthcare systems, providers, health workers, and communities. The model articulates responsibilities for stakeholders and visualizes processes to increase access to and coverage of prevention methods. We discuss the challenges of contextual factors and highlight innovation needs. Effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing, and thermocoagulation. However, vaccine coverage remains low in LMICs. New strategies, including single-dose vaccination could enhance impact. Loss to follow-up and treatment delays could be addressed by improved same-day screen-and-treat technologies. We provide a practical framework to guide cervical cancer elimination in LMICs. The scoping review highlights existing and innovative strategies, unmet needs, and collaborations required to achieve elimination across implementation contexts.世界卫生组织（World Health Organization）发出了一项雄心勃勃的呼吁，旨在在全球范围内消除宫颈癌。依托现有预防与诊疗手段，宫颈癌消除对于高收入国家而言已触手可及。尽管中低收入国家（low-and-middle-income countries, LMICs）存在资金投入不足、服务能力受限的问题，但通过整合式卫生服务与新兴技术，仍可为其宫颈癌防控工作提供有力支撑。本研究开展此次范围综述（scoping review），旨在勾勒中低收入国家消除宫颈癌的行动路线图，并突出循证干预措施与研究重点，以加速宫颈癌消除进程。我们回顾并整合了2010至2020年间发表的关于宫颈癌一级、二级预防策略的相关文献。此外，我们还对妇科与传染病诊疗医师、科研人员以及中低收入国家的卫生官员开展了专家访谈。基于上述研究资料，我们构建了一套逻辑模型（logic model），用以梳理当前的科学研究现状，并明确各项预防策略对应的证据缺口与优先研究问题。本次宫颈癌消除逻辑模型明确了政策制定者、产品生产与供应链方、医疗体系、诊疗人员、医护工作者以及社区群体之间加强协作的迫切需求。该模型清晰界定了各利益相关方的职责，并可视化呈现了提升预防手段可及性与覆盖范围的实施路径。本研究同时探讨了不同情境因素带来的实施挑战，并明确了相关创新需求。当前有效的宫颈癌预防手段包括人乳头瘤病毒（Human Papillomavirus, HPV）疫苗接种、采用目视检查与HPV检测的筛查方式，以及热凝治疗。但中低收入国家的HPV疫苗接种覆盖率仍然偏低。包括单剂次HPV疫苗接种在内的新型策略，可进一步提升防控效果。优化后的当日筛查即治疗技术，可有效解决失访与治疗延误问题。本研究为中低收入国家的宫颈癌消除工作提供了一套实用指导框架。此次范围综述梳理了现有与创新型防控策略、尚未满足的卫生需求，以及在各类实施场景下实现宫颈癌消除所需的协作机制。