Gina Ogilvie

Introduction: Cervical cancer disproportionately affects women in low‐ and middle‐income countries (LMICs), where limited healthcare infrastructure often shifts caregiving responsibilities to informal companions such as family members, spouses, and friends. The goal of this scoping review is to map and summarize the social and economic impacts of cervical cancer on the caregivers for women diagnosed with cervical cancer in LMICs. Methods: Three databases were searched up to March 30, 2026. Studies were included if they were conducted in a LMIC, included caregivers or companions of cervical cancer patients, and reported on social or financial outcomes. Outcomes were categorized into social impacts (psychosocial burden, education, social support, and sexual relationships) and economic impacts (employment and financial security). Results: Fifteen unique studies from 11 countries were included (11 cross‐sectional and 4 qualitative), and caregiver sample sizes ranged from 7 to 360. Caregivers were predominantly middle‐aged, with low to moderate educational attainment and income. Up to 72.1% of caregivers experienced high levels of psychosocial burden. Educational disruptions were reported, with up to 28% of households reporting difficulties paying for education and school absences among family members. Social support experiences varied, with most caregivers reporting stable family relationships but some reporting neglect of other family members. Employment was significantly disrupted, with up to 61% of companions reducing working hours and 28% of households having a member stop working entirely. Financial hardship was pervasive: up to 39% of households experienced partial or total income loss, and coping strategies included selling assets, reducing food consumption, and accumulating debt. Conclusion: Cervical cancer inflicts substantial social and financial consequences on caregivers in LMICs, spanning psychosocial distress, educational disruption, employment loss, and financial hardship. These impacts are shaped by gender dynamics and intergenerational caregiving roles. As the global community pursues cervical cancer elimination, policies integrating caregiver support are essential.

Objective: This study evaluates the feasibility and acceptability of using short message service (SMS) as a recruitment strategy for cervical cancer screening in an urban sector of Kigali, Rwanda. Methods: This pilot invited 300 women who had not attended cervical screening during the local campaign and had access to a mobile phone to provide a mobile number for cervical cancer screening invitation. Up to three SMSs were sent out, inviting women to visit a local health center for cervical cancer screening. There, attendance rates were recorded, self‐collected vaginal samples for human papillomavirus testing were taken, and a short survey was administered. Those who did not attend received a phone call and were surveyed on reasons for non‐attendance. A descriptive analysis was used to detail attendance rates and evaluate survey questions on the perceived feasibility and acceptability of the intervention. Results: A total of 294 women met the inclusion criteria. Of these women, 86.4% (254/294) attended the health center for cervical cancer screening and 92.9% (236/254) of attendees reported they participated due to the SMS reminder. Survey items evaluating acceptability and feasibility indicated high message comprehension, strong attendance following a single SMS prompt, and high agreement that SMS was a helpful reminder to attend screening. Most non‐attendees reported having received the SMSs but not attending due to circumstantial factors. Conclusion: SMS recruitment was highly feasible and well accepted in this pilot study in an urban sector of Kigali, Rwanda. Future research should aim to understand the efficacy of this strategy compared to usual recruitment methods across diverse settings in Rwanda.

Evidence on the comparative effectiveness of HPV testing versus cytology specifically in women aged ≥ 50 years who are approaching screening cessation remains limited. This analysis included 6471 women aged ≥ 50 at baseline screening in the HPV FOCAL randomized clinical trial. Women were randomly allocated to receive cytology (Control Group, n = 3248, 50.19%) or HPV testing (Intervention Group, n = 3223, 49.81%) at baseline, with co‐testing at 48‐month exit. We calculated incidence rates and risk ratios for CIN2+ detection over follow‐up and compared missed lesions at exit by screening method. At the 48‐month exit, CIN2+ detection was lower among HPV baseline‐negative women than among those in the cytology group (1.61/1000 [95% CI, 0.52–3.76] vs. 3.15/1000 [95% CI, 1.51–5.78]; risk ratio, 0.51 [95% CI, 0.11–0.91]), reflecting higher baseline detection with HPV testing and fewer prevalent lesions at exit. Even with cytology re‐screening at 2 years, 50% of CIN2+ cases were missed compared to 30% with HPV testing. After adjusting for age, education, smoking status, and lifetime sexual partners, the hazard ratio for CIN2+ comparing HPV to cytology was 0.44 (95% CI, 0.22–0.88). Among women aged ≥ 50 years, HPV primary screening was more effective than cytology at detecting CIN2+ lesions and was associated with a continued lower subsequent risk following a negative HPV test, supporting its use in cervical cancer screening programs in this age cohort.

Introduction Every 2 minutes, a woman dies from cervical cancer, resulting in over 300 000 preventable deaths globally. Nearly all cervical cancers are caused by human papillomavirus (HPV) and are preventable with HPV vaccination and screening through Papanicolaou (Pap) and HPV tests. In Canada, cervical cancer mortality rates have declined in recent decades with more accessible cervical cancer screening programmes. However, screening rates remain low, particularly among Black women and people with a cervix (WPC). Cervical cancer screening studies of Black WPC in Ontario—Canada’s most populous province—are limited. These studies indicate Black WPCs are at elevated risk for under-screening, with many overdue for screening. An innovative approach to begin addressing delays is HPV self-sampling (HPVSS). Self-sampling is a cost-effective and more accurate test for detecting high-risk HPV infections associated with precancerous changes versus the Pap test. Self-sampling supports Canada’s action plan—a response to WHO’s global strategy—to eliminate cervical cancer by 2040. Despite Canada’s plan, research on the state of Black WPCs’ HPV knowledge and self-sampling interventions tailored to them is scant. These scarcities are concerning as Ontario plans to implement HPV primary screening and offer HPVSS soon. The study objective is to codevelop an HPVSS intervention tailored for and made by Black WPC in Peel region, Ontario. This protocol focuses on phase one of a two-phased study. Methods and analysis In phase one, a qualitative, community-informed approach, co-led by community research assistants, will be used to purposively recruit 10 service providers (eg, clinicians, social workers, community care workers) and 40 Black WPC who will undergo one-on-one semistructured interviews and sociodemographic surveys to explore the state of: (1) Black WPC’s level of HPV, cervical cancer and cervical cancer screening knowledge; (2) Black WPC’s motivators, beliefs, attitudes and misconceptions towards HPVSS; (3) Black WPC’s perceived barriers and facilitators to HPVSS and (4) service providers’ perspectives on Black WPC’s barriers and facilitators to HPVSS. Charmaz’s grounded theory approach and intersectionality will guide data collection and analysis. Ethics and dissemination Ethical approval has been obtained from the Trillium Health Partners Research Ethics Board (ID#1207). Study findings will be disseminated through community healthcare events, conference presentations, peer-reviewed publications and virtual and physical pamphlets. Additionally, summaries of the findings will be shared and tailored to collaborators, healthcare leadership and researchers and community health centres. Wide dissemination will help enhance understanding of the state of cervical cancer screening, HPV and HPVSS among Black WPC. Given Canada’s commitment to eliminating cervical cancer, study findings will be used to begin developing an HPVSS intervention for Black communities.

Background/Objectives: Our objective was to determine the acceptability of and attitudes towards HPV self-sampling among women with HIV and investigate any associations between self-sampling attitudes and participant demographic and clinical characteristics. Methods: Women with HIV aged 18–45 were given a description of HPV self-sampling and instructions on how to self-collect the sample. Participants completed a questionnaire assessing their perceptions of the acceptability and comfort of HPV self-sampling before using the self-sampling methodology. Responses were based on a 5-point Likert scale (strongly agree to strongly disagree) for each statement. Participants’ characteristics were included in bivariate analysis. Chi-square and Fisher’s exact tests were used to assess associations between questionnaire results and participant characteristics. Results: Of the 117 completed questionnaires, 79.6% of participants had a CD4+ T cell count ≥ 500 cells/mm³. Participants’ median age was 39 (IQR 34–43). One hundred participants (85.5%) felt confident they could collect their samples correctly, and 77.8% did not think they would experience difficulties with self-collection. Most participants (68.4%) preferred to self-collect their sample instead of provider-collected sampling. Ninety-six participants (82.1%) agreed they would likely use self-collection methods for future cervical screening. Many participants were concerned about receiving a positive HPV result (68.4%), passing HPV on to their partner(s) (75.7%), and disclosing their HPV status to friends/family (49.6%). Conclusions: Women with HIV seem to be accepting of HPV self-sampling as a cervical cancer screening methodology; however, many participants were concerned about the implications associated with a positive HPV test result.

Introduction The Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE. Methods and analysis QUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1–3 doses of the quadrivalent or nonavalent HPV vaccine at 9–14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9–14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4–5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20–27-year-old females vaccinated at 9–14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16–26 years of age up to 12 years postvaccination. Ethics and dissemination QUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children’s and Women’s Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.

Uganda has one of the highest incidence rates of cervical cancer in the world. Although this impacts all women, women living with human immunodeficiency virus (HIV) experience an increased risk for developing cervical cancer. This study aims to compare how HIV-positive and HIV-negative women in a remote sub-county in Uganda access health services to inform consideration of potential HIV and HPV-based cervical cancer screening integration at the community level. Women were recruited for this cross-sectional study door-to-door by village health teams if they had no prior screening or treatment of cervical cancer, no previous hysterectomy, were 30–49 years old residents of the South Busoga District Reserve, and could provide verbal informed consent. Participants completed a baseline survey, which included questions on HIV status, demographics, prior health history, past healthcare access and services recieved. The data was analyzed using bivariate descriptive statistics. Among the 1437 participants included in the analysis, 8.8% were HIV-positive. The majority of the respondents were between 30–34 years of age, were married, had received primary education or higher, and were farmers. The majority of women in both groups had accessed outreach visits (HIV-positive = 89.0%, HIV-negative = 85.8%) and health centres (HIV-positive = 96.1%, HIV-negative = 80.2%). The most commonly received services among both groups of women at outreach visits and health centres were immunization and antenatal care, respectively. Our study demonstrated that there were no significant differences in healthcare access between HIV-positive and HIV-negative women in rural Uganda. Additionally, the high usage of healthcare services by women living with HIV suggests that the integration of cervical cancer and HIV screening may facilitate early detection and prevention of cervical cancer among this population. This can reduce the burden of disease in Uganda and further contribute to the World Health Organization’s initiative to eradicate cervical cancer.

Background: Cervical cancer is a major global health concern, causing approximately 350,000 deaths annually. It is also preventable through effective prevention and early detection. To facilitate elimination, the World Health Organization (WHO) set targets for HPV vaccination, screening, and treatment. Achieving these goals requires frameworks to monitor screening program performance. As many regions transition to HPV primary screening, a standardized Cervical Cancer Screening Cascade can track performance, identify gaps in follow-up, and optimize resource allocation. Methods: This paper introduces a structured cascade developed to monitor uptake, retention, and outcomes in HPV-based screening programs. The Cascade was created through collaboration between public health experts, clinicians, and researchers at the University of British Columbia (UBC), the Women’s Health Research Institute, and BC Cancer. Results: The Cascade outlines four phases: screening, triage, detection, and treatment. Each phase includes two substages: “uptake” and “results,” with an additional substage in screening (“invitation”). “Screening” assesses invitation effectiveness and participation. “Triage” tracks follow-up after a positive screen. “Detection” evaluates attendance at diagnostic appointments, and “Treatment” measures the treatment rate for those with precancerous lesions. Conclusions: The Cascade can guide emerging and existing HPV screening programs within Canada and other similarly resourced settings and serve as a benchmark tool for programs to assess their progress towards cervical cancer elimination.

Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners.

Objective: This study aims to compare how HIV-positive and HIV-negative women in a remote sub-country in Uganda access health services to inform consideration of potential HIV and HPV-based cervical cancer screening integration at the community level. Methods: This cross-sectional study recruited women living in the South Busoga District Reserve from January to August 2023. Women were eligible if they were aged 30 to 49 years old, had no history of cervical cancer screening or treatment, had no previous hysterectomy, and could provide informed consent. Participants completed a survey administered by village health teams, which included questions on HIV status, demographics, healthcare access, and services received. The data was analyzed using bivariate descriptive statistics, including chi-square and Fisher’s exact tests. Results: Among the 1437 participants included in the analysis, 8.8% were HIV-positive. The majority of the respondents were between 30-39 years of age, were married, had received primary education or higher, and were farmers. The majority of women in both groups had accessed outreach visits (HIV-positive = 89.0%, HIV-negative = 85.8%) and health centres (HIV-positive = 96.1%, HIV-negative = 80.2%). The most commonly received services among both groups of women at outreach visits and health centres were immunization and antenatal care, respectively. Conclusion: Our study demonstrated that there were no significant differences in healthcare access between HIV-positive and HIV-negative women in rural Uganda. Additionally, the high usage of healthcare services by women living with HIV suggests that the integration of cervical cancer and HIV screening may facilitate early detection and prevention of cervical cancer among this population. This can reduce the burden of disease in Uganda and further contribute to the World Health Organization’s initiative to eradicate cervical cancer.