Abstract
The COVID-19 pandemic disrupted many public health programs; understanding these disruptions is critical for directing future resources. In a project studying the implementation of human papillomavirus (HPV) testing-based cervical cancer screening, we queried about the impact of the pandemic on screening programs globally. In consultation with World Health Organization's Regional Advisors, program managers, government officials, and clinicians involved in the implementation of HPV testing-based cervical cancer screening programs were invited to participate in semi-structured, in-depth, interviews. Interview notes and transcripts were used for inductive analysis, focusing on responses to the impact of COVID-19 pandemic on screening programs. Thirty-two interviews were conducted with participants between the age of 29 and 61 years, representing programs from 25 countries. Six key themes were noted. Regarding disruptions, (1) the entire cancer continuum was affected, leading to delays or, in some cases even cessation of vaccination, screening, and treatment programs; and (2) a heightened sense of fear around contracting and transmitting COVID-19 shifted government priorities and impacted healthcare delivery. Nonetheless, participants noted constructive ways in which programs leveraged the impact of the pandemic: (1) at the community level, participants were able to leverage an increased understanding and acceptance surrounding the importance of preventive health behaviors; (2) for HPV-testing: molecular laboratories became well-equipped with better technician training, increasing overall HPV-testing capacities; (3) the pandemic promoted virtual healthcare systems; and (4) for planning: shutdowns allowed time to plan for program scale-up. In many ways, the pandemic response provided evidence supporting countries' abilities to mobilize resources. While disruptions were noted, the pandemic provided implementers with opportunities to strengthen screening programs, which should be further assessed in future sustainability research on cervical cancer prevention and control.