Research Project: A hybrid type III effectiveness-implementation, pragmatic intervention trial for cervical cancer screen and treat in Mozambique

Overview

PROMETA tests the best ways to deliver a Screen-Triage-Treat approach to cervical cancer screening for women living with HIV in Mozambique. Women collect their own samples for HPV DNA testing, and screening and treatment take place inside existing HIV care and treatment services in Chókwè District.

Why This Matters

The World Health Organization recommends HPV DNA testing for cervical cancer screening, and Mozambique's Ministry of Health has endorsed it. HPV is common among women living with HIV, so many of them will need follow-up care. Offering treatment, such as thermal ablation, at the primary care level could ease the load on specialized services. This study aims to build the evidence needed to support national scale-up in Mozambique's busy HIV clinics.

Our Approach

PROMETA is a hybrid type III effectiveness-implementation trial. It focuses mainly on how well the approach can be delivered in everyday services, while also tracking results. The team uses a mixed-methods design that collects both numbers and the experiences of women and clinic staff. The study has three goals.

• Understand each step of the Screen-Triage-Treat care pathway, working with local stakeholders
• Evaluate how well the approach works
• Use the Consolidated Framework for Implementation Research to explain why results differ across clinics and providers

The work is shared across partners.

• Eduardo Mondlane University leads and oversees the integration of Screen-Triage-Treat into HIV care and treatment services
• Tulane leads the design and execution of the implementation science agenda to identify the best service delivery approaches
• MD Anderson works with Eduardo Mondlane University, Tulane, and the Ministry of Health to support the health facility staff who screen, treat, and refer
• Vanderbilt University Medical Center co-investigators provide biostatistics support

What We Are Measuring

Recruitment is set to begin in August 2026.

• Primary outcomes are the number of women screened and the share of screen-positive women who go on to receive treatment
• Secondary outcomes look at other implementation measures, including what helps or hinders delivery in each clinic

Potential Impact

If the approach works, the findings will inform future research to take Screen-Triage-Treat to scale across Mozambique.

Publication

Moon TD, Salcedo MP, Mavume-Mangunyane E, Sidat M, Lorenzoni C, Baker E, Amorim G, Paz-Soldán VA, Kampa KT, Condon K, Myers H, Sacarlal J. A hybrid type III effectiveness-implementation study to test implementation best practices of deploying a Screen-Triage-Treat approach to cervical cancer screening and management utilizing self-collected HPV DNA testing in Chókwè District, Mozambique. BMC Public Health. 2025 Nov 25;26(1):6. PMID 41291606. PMCID PMC12763959.

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