How Does Transitioning to Primary Human Papillomavirus Screening Impact Colposcopy Services? Lessons From an...

Area of Science:

• Public Health
• Gynecologic Oncology
• Health Services Research

Background:

• Australia transitioned its National Cervical Screening Program in 2017.
• The program shifted from 2-yearly cytology to 5-yearly primary human papillomavirus (HPV) testing.
• The Stakeholder Opinions of Renewal Implementation and Experiences Study (STORIES) was initiated to gather insights.

Purpose of the Study:

• To assess stakeholder perspectives on the implementation of the renewed National Cervical Screening Program.
• To evaluate experiences with colposcopy services during the transition to HPV-based screening.

Main Methods:

• Qualitative semistructured interviews were conducted with key stakeholders.
• Interviews occurred 11-20 months post-transition via face-to-face, online, or phone.
• Colposcopy service data were thematically analyzed using Proctor's framework for implementation outcomes.

Main Results:

• Four themes emerged: non-adherence to guidelines, lack of preparedness, unintended consequences, and mitigation strategies.
• Increased colposcopy referrals were observed but were inequitably distributed.
• Referral issues were linked to confusion regarding or overuse of symptom-based testing.

Conclusions:

• This study offers the first stakeholder-based assessment of colposcopy services during the cytology-to-HPV screening transition.
• Effective transition requires robust stakeholder communication, clear guidelines (especially for symptoms), and adequate colposcopy service resourcing.
• Ensuring equitable and timely colposcopy access is crucial for successful program implementation.