Abstract
Longstanding structural barriers to Pap smear-based cervical cancer screening and treatment have existed in Peru for decades. The objective of this study was to understand healthcare providers' perspectives regarding the facilitators of and barriers to the now former Pap/Visual Inspection with Acetic Acid-based cervical cancer prevention program in Iquitos, Peru, to inform the transition to the human papillomavirus (HPV) molecular testing-based screen-and-treat intervention to increase screening and completion of care. We used constructs from the Consolidated Framework for Implementation Research's Inner Setting domain to understand the strengths and failures of the former system and leverage this knowledge to enhance the new HPV-based intervention's implementation. We conducted 19 semi-structured interviews with health professionals (12 nurse-midwives, 4 doctors, and 3 laboratory technicians) who administered the former Pap smear-based cervical cancer early detection and treatment program. Providers identified information gaps between the primary level of care, where cervical cancer screening occurs, and the hospital level of care, where diagnosis and treatment occurs. These gaps, caused in part by fragmented and overlapping data systems that do not connect with one another, as well as by healthcare professionals tending to concentrate solely on their own specific role, rather than recognizing the importance of all components working cohesively to facilitate completion of the continuum of care, resulted in the loss of patients between levels of care. Participants also noted a lack of trained personnel and basic materials. Some providers found their way around these gaps by facilitating informal information exchanges among providers to ensure women were not lost to follow-up. Proyecto Precáncer leveraged these findings by collaborating with stakeholders to map the former system, reach stakeholder consensus on system inefficiencies, and design an intervention that improved system efficiencies through a patient-centered approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43477-025-00164-8.