Implementation science research to understand the readiness of a mobile clinic intervention to screen for high-risk HPV infections and associated morbidity in Mali and Nigeria.

Abstract

Access to and community acceptance of point-of-care testing for high-risk human papillomavirus (hrHPV) are vital to cervical cancer (CC) prevention. The World Health Organization (WHO) reports high rates of HPV-16/18 (oncogenic hrHPV strains) in Sub-Saharan Africa (SSA). In rural Mali and peri-urban Nigeria, prevention efforts are limited by cognitive, socio-cultural, logistical, and resource-related barriers, leading to ongoing transmission, late diagnoses, limited treatment options, and preventable deaths. To address these barriers, we prepared a mobile clinic intervention providing self-sample collection and rapid hrHPV testing. Pre-implementation research assessed factors influencing success in both countries. Using implementation science methods, focus groups per target community were conducted with political/administrative, religious, business, community leaders, and women of screening age. Participants also completed a short survey on HPV knowledge. Data were analysed using descriptive statistics and thematic analysis. From January 2024 to January 2025, planning occurred alongside the mobile clinic's manufacturing and shipping. Eighteen focus groups were held between January and March 2025 - ten in Mali (with additional sessions for marketplace leaders) and eight in Nigeria. Results will inform site-specific adaptations. A follow-up study will document real-time implementation adjustments to support scale-up. Culturally tailored, context-specific strategies are key to addressing disparities in HPV-related cancer prevention. Implementation science can assess community readiness and guide effective intervention delivery.