Regionalization of the Care Pathway as a Strategy for Organized Screening and Timely Access in Cervical Cancer

Cervical cancer remains one of the main preventable causes of death among women in Brazil. Persistent infection by oncogenic human papillomavirus (HPV) genotypes is the primary etiological factor associated with the development of this neoplasm. This is an experience report based on healthcare data generated by the Program. This study describes the results of implementing a regionalized screening strategy using HPV testing in a Health Region in Northeastern Brazil, with the aim of improving early diagnosis and expanding access to specialized procedures. The intervention began in September 2023, with HPV testing by Reverse Transcriptase coupled with polymerase chain reaction (RT-PCR) in Primary Health Care. Samples positive for genotypes 16 and 18 were referred for colposcopy, and those positive for other high-risk genotypes were directed to liquid-based cytology. Care pathways were organized in stages, with regionalization of colposcopy and high-frequency surgical services, accessed through state-level referral. During the analyzed period, 13,988 HPV tests were collected in 22 municipalities. Of these, 12,108 (86.6%) had results released. The overall positivity rate was 11.3%, with 206 cases of HPV 16 (1.7%), 73 of HPV 18 (0.6%), and 1,059 of other high-risk types (8.7%). In the III Health Region, the eight municipalities participating in the first implementation phase exceeded the annual coverage target, with 7,270 samples collected compared to a target of 6,335, representing 114.8% of the expected. Based on the organized care flow, 359 women were scheduled for colposcopy and 81 for high-frequency surgery. The data analyzed refer to the period from September 2023 to August 2024, according to records extracted from the GAL system (Laboratory Environment Manager). Regionalization of screening and the care pathway proved effective, with strong adherence to testing and rationalization of referrals. The results reinforce the potential for expanding the strategy to other regions, contributing to the control of cervical cancer as a preventable health condition. The strategy also aligns with the World Health Organization’s goal of eliminating cervical cancer as a public health problem by 2030.