Overcoming workforce shortages to improve cervical cancer detection: a community approach in Ukraine

Abstract Cervical cancer (CC) remains a major health challenge in Ukraine, with around 3,000 new cases and over 1,500 deaths annually. Alarmingly, nearly 50% of cases are diagnosed at stages II-IV, significantly limiting treatment success. Despite available screening methods, coverage remains below 20%, due in part to a 20-30% reduction in healthcare personnel from displacement and the ongoing war, especially in rural areas. In October 2023, Pact launched a CC screening program in 6 communities, with a focus on improving access for rural women. The key question: how to increase screening rates amid workforce shortages and disrupted care pathways. The initiative included: • Training 146 primary healthcare (PHC) nurses in smear sampling and 140 PHC staff in motivational counseling; • Conducting awareness campaigns and direct outreach to women; • Establishing regional SOPs for referral of cytological samples and local protocols for patient navigation; • Expanding screening services to rural ambulatory clinics. As a result, 7,472 rural women were screened for cervical cancer using Pap tests, leading to the detection of 9 cases - 88% of which were identified at early stages (in situ or stage I). Additionally, 1,155 women were tested for HPV, with 12 positive cases detected. More than 300 women received specialist consultations following referrals from PHC providers. Notably, the majority of women screened had never previously participated in CC screening, highlighting a significant improvement in reaching underserved populations. Empowering PHC nurses to perform smear sampling significantly expanded rural access to CC screening. Nurses - previously not engaged in this service - became central to delivering preventive care. Reducing stigma and fear around screening was crucial for improving uptake and linkage to care. Integrating screening into PHC services helped overcome systemic barriers and enabled earlier diagnosis. Key messages • Empowering and training PHC nurses is critical for expanding essential services and increasing cervical cancer screening, especially in settings with healthcare workforce shortages. • Building clear patient pathways and strong collaboration between PHC teams and specialists is essential to ensure timely diagnosis and treatment.