Implementing a Sustainable Cervical Cancer Screening Program into a Resource-Limited Pacific Island Nation: Yap State, Federated States of Micronesia

PURPOSE The North Pacific Islands have extreme cervical cancer (CC) rates (ASR 20.0-65.4 per 100,000 women per year), including Yap State, Federated States of Micronesia. A CDC-funded Pacific Against Cervical Cancer (PACe) Project was developed with the Yap Department of Health Services in the context of Yap’s 22 islands, dispersed over 500,000 square miles of ocean. The PACe worked to implement a high-quality, technologically feasible, effective CC screening system in Yap’s health resource-limited islands to address the high CC burden. METHODS Using a co-development strategy, principles of participatory capacity building were the foundational project elements. The EPIS framework (exploration, preparation, implementation, and sustainment) guided the implementation process. A multi-disciplinary team comprising CC medical, laboratory, community engagement, data/registry, and medical modeling/micro-costing experts was assembled. Through training, an hrHPV DNA screening program was linked to a visual assessment and thermal ablation follow-up protocol for pre-cancer treatment. A CC registry was deployed. The real-time results were analyzed through the modeling and micro-costing teams. RESULTS The PACe provided training to six doctors and five nurses, 16 community health workers, and 15 staff on the CC digital registry. A WHO-aligned triage and treatment algorithm that utilizes thermal ablation was developed. An electronic specimen tracking and client follow-up system was deployed. Over 2.5 years, 18 outer islands and Yap’s main island were covered. 100% of its screening goal (1,600 women) was achieved with a 20% hrHPV positivity rate. 62% of participants had never been screened. An hrHPV self-sampling strategy was instituted. Modeling indicated that Yap can achieve a threshold of ASR 4/100,000 by 2030. CONCLUSION Using a co-development, capacity-building, participatory framework was essential for the project's success. The EPIS framework ensured a process to systematically guide the project development towards sustainability. A multi-disciplinary expert team of medical, laboratory, community engagement, data, and medical modeling provided the evidence-based pieces for all technical components. The PACe project provides a scalable model to reduce CC mortality in underserved Pacific regions. These activities can significantly reduce CC mortality and ensure access for rural regions.