Community Determinants Shaping Readiness for Mobile Cervical Cancer Test-and-Treat Services in Mali and Nigeria
Kate Klein, Imran Morhason-Bello, Brehima Diakete, Mamoudou Maiga, Lifang HouPURPOSE
Cervical cancer remains a leading cause of preventable morbidity and mortality in low- and middle-income countries (LMICs), driven by numerous structural and cultural factors, including limited access to and acceptance of high-risk human papillomavirus (hrHPV) screening. Mobile test-and-treat models offer a promising strategy to expand access in rural settings, yet successful implementation requires strong community readiness and engagement. We conducted a pre-implementation assessment to identify community-level determinants influencing readiness, acceptability, and feasibility of mobile hrHPV screening in Mali and Nigeria.
METHODS
A mixed-methods study was conducted in four communities in Nigeria and two communities in Mali; intended sites for a mobile van hrHPV test-and-treat intervention. Guided by the Consolidated Framework for Implementation Research, we administered quantitative surveys and conducted qualitative focus group discussion with political, religious, and civic leaders and with women aged 25-65 in each community. Quantitative data were summarized descriptively. Qualitative data were collaboratively coded by partners in Mali, Nigeria, and the United States. Cross-site matrices were used to compare implementation barriers, facilitators, and readiness indicators across communities and stakeholder groups.
RESULTS
Community readiness for mobile hrHPV screening varied across sites. Leaders consistently expressed strong support for mobile services but emphasized the need for structured community mobilization, trusted local messengers, and culturally appropriate communication strategies. Women reported enthusiasm for accessible screening while also expressing concerns related to stigma, fear of positive results, and misconceptions about HPV and cervical cancer. Communities with prior exposure to HPV vaccination or mobile health programs demonstrated higher trust, fewer misconceptions, and greater anticipated uptake. Structural barriers, including travel distance, competing responsibilities, and limited engagement with preventive health services, were more pronounced in lower-readiness communities.
CONCLUSION
Pre-implementation assessments are critical to the success of mobile HPV screening programs in LMICs. Findings highlight the importance of tailored community engagement, targeted health literacy strategies, and alignment with existing community structures to improve acceptability, equity, and scalability of mobile hrHPV test-and-treat services in Mali and Nigeria.