Delivering cervical cancer screening and management to women in remote communities of the Peruvian Amazon: a mixed methods analysis of a mobile point-of-care intervention.

Abstract

Cervical cancer disproportionately affects women in remote and underserved settings, where access to screening, timely results, and treatment is limited. HPV-based screen-and-treat (SAT) strategies can reduce loss to follow-up, but their implementation in hard-to-reach contexts remains challenging. In the Peruvian Amazon, riverine communities face extreme geographic barriers to cervical cancer prevention. This study describes the implementation, screening volume, feasibility, and context-driven adaptations of a mobile, point-of-care HPV-based SAT intervention delivered aboard government-operated ships serving remote Amazonian communities. We conducted a mixed-methods study using intervention campaign indicators from ship reports and semi-structured interviews. Quantitative indicators were collected for all women participating in four six-week campaigns conducted between 2023 and early 2025 on three ships: HPV screening, result delivery, visual assessment for treatment, thermal ablation, referrals, and completion of the care continuum. Qualitative interviews with health personnel and program authorities assessed intervention feasibility and adaptations required for mobile and intercultural settings. Across four campaigns, 330 women were screened for HPV, representing a ten- to twenty-fold increase compared with prior ship-based screening approaches. Nearly all women received their results (99%), and most HPV-positive women completed same-day visual assessment and treatment with thermal ablation. Health personnel reported high feasibility and acceptability of self-sampling, same-day results, and on-board treatment. Engagement with local leaders and culturally adapted counseling were central to implementation. A mobile, point-of-care HPV-based screen-and-treat strategy delivered aboard river ships is feasible and enabled completion of the cervical cancer care continuum in extremely remote settings, supporting context-responsive approaches to advance equitable cervical cancer elimination. National Institutes of Health/National Cancer Institute (grant ID R01/U01-CA190366).