Factors influencing implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala Municipal Council, Dar es Salaam Tanzania: a qualitative study

Factors influencing implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala Municipal Council, Dar es Salaam Tanzania: a qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors influencing implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala Municipal Council, Dar es Salaam Tanzania: a qualitative study Ludovick Kessy, Gladys Reuben Mahiti, Anna Tengia Kessy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7982412/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Cervical cancer is a leading cause of cancer-related deaths among women in Tanzania. To address this burden, the Ministry of Health adopted the Screen-and-Treat Single Visit Approach (ST-SVA), which involves screening with Visual Inspection using Acetic Acid (VIA) and providing same-day treatment for precancerous lesions. Despite its effectiveness, little is known about the factors influencing its implementation. Methods A qualitative phenomenological design was employed to two health facilities that is Mnazi Moja Hospital and Amana Regional Referral Hospitals in Ilala Municipal Council, Dar es Salaam. Nine healthcare providers were purposively selected and interviewed using semi structured interview guides. Data were analyzed thematically, with the support of NVivo 14 software. Results The study identified four key factors affecting the implementation of the screen-and-treat approach. Providers demonstrated varied interpretations of screening guidelines, sometimes extending services to younger women considered at higher risk. Women’s acceptance of same-day treatment was shaped by post-treatment abstinence requirements, fears and misconceptions about procedures, and the influence of peers or family members. Service delivery was further constrained by limited refresher training, staff shortages, and reliance on on-the-job learning. In addition, dependence on donor support and frequent equipment breakdowns disrupted continuity of services. Conclusion This study demonstrates that the implementation of the screen-and-treat single-visit approach in Ilala is influenced by factors at the provider, client, and health system levels. Strengthening provider training, enhancing follow-up support for women, and ensuring reliable and sustainable supply chains are essential steps to improve the effectiveness and sustainability of cervical cancer prevention efforts in Tanzania. Cervical cancer Screen-and-Treat Single Visit Approach Implementation Introduction Cervical cancer is the fourth most common cancer among women globally, with 662,301 new cases and 348,874 deaths estimated in 2022( 1 ). Nearly 85% of these occur in low- and middle-income countries (LMICs), where limited access to preventive services contributes to late diagnosis and poor outcomes( 2 , 3 ). In Tanzania, cervical cancer is the leading cause of cancer-related deaths among women, with approximately 10,868 new cases and 6,832 deaths annually( 4 ). Persistent infection with high-risk strains of human papillomavirus (HPV) is the main cause of cervical cancer( 5 ). Other risk factors include HIV infection, multiple sexual partners, high parity, and early sexual debut( 1 ). While the disease is preventable through HPV vaccination and screening for precancerous lesions, uptake of cervical cancer screening services in Tanzania remains low: According to the Tanzania demographic health survey only 7% of women have ever been screened( 4 ), far below the World Health Organization (WHO) target of screening 70% of eligible women at least twice in their lifetime by 2030. To bridge this gap, Tanzania’s Ministry of Health adopted the Screen-and-Treat Single Visit Approach (ST-SVA). This model involves screening with Visual Inspection using Acetic Acid (VIA) and treating precancerous lesions on the same day using cryotherapy, thermal coagulation, or Loop Electrosurgical Excision Procedure (LEEP)( 6 ). The single-visit design minimizes loss to follow-up and is more feasible in low-resource settings than cytology or HPV-based testing requiring multiple visits( 7 ). Although the ST-SVA has demonstrated effectiveness in reducing cervical cancer incidence in LMICs, its successful implementation depends on contextual factors at the health system, provider, and client levels. However, studies in sub-Saharan Africa suggest that its implementation is influenced by a range of provider, client, and system-level factors. These include limited provider training and refresher courses, stockouts of consumables, equipment failures, staff shortages, and weak follow-up mechanisms( 8 – 10 ). Furthermore, non-adherence to national screening guidelines, client fears and misconceptions, and dependence on donor support for supplies have been documented as barriers in similar contexts ( 8 – 10 ).While such barriers have been reported in countries like Ethiopia, Kenya, and Rwanda, there is limited evidence on how they shape implementation in Tanzania. Understanding these contextual influences is critical to strengthening prevention efforts and achieving national and global targets. This study therefore explores the factors influencing healthcare providers’ implementation of the ST-SVA in Ilala Municipal Council, Dar es Salaam. The objective was to identify the factors influencing implementation of the ST-SVA in order to inform strategies for strengthening cervical cancer prevention in Tanzania. Materials and Methods Study Design and Settings The study engaged phenomenological design with semi structured key informant interviews as a data collection method owing to its usefulness in extracting information on a specific phenomenon ( 11 ). The study was conducted at two high-volume health facilities in Ilala Municipal Council: Amana Referral Hospital and Mnazi Mnazi Hospitals both the Dar es Salaam Region: Recruitment of participants. Purposive sampling was used to recruit nine cervical cancer prevention program healthcare workers and administrative staff with varying levels of experience. This allowed for the intentional selection of individuals who had direct involvement in the program and provided valuable insights based on their specific roles and experiences( 12 , 13 ). Recruitment of participant continued until data saturation was achieved, ensuring that no new themes or information emerged( 14 , 15 ). Data collection. Semi-structured Key informant interviews were conducted in Swahili between May and June 2025 by the first author (LK). The interview guide explored provider experiences with ST-SVA implementation, challenges faced, and perceptions of client and system-level influences. The interviews were conducted in Swahili, a language all the study participants spoke. Probing questions helped better understanding of the participants’ opinions and experiences regarding the factors influencing. Interviews lasted 25–35 minutes, were audio-recorded with consent. The audio-recorded files were transcribed verbatim and the transcripts were saved as Word files. To ensure the quality and accuracy of the transcripts, the authors reviewed the transcripts against the audio recordings before they were imported into the qualitative data management software (QS Nvivo version 14) for analysis Trustworthiness To ensure trustworthiness, the study applied the Guba criterions for qualitative rigor: credibility, confirmability, transferability, and dependability ( 13 , 16 ). Credibility was enhanced by purposively selecting healthcare workers directly involved in the Screen-and-Treat Single Visit Approach (ST-SVA), ensuring that data reflected lived experiences. Findings were further validated through triangulation, where interview narratives were compared with field observations to strengthen reliability. Confirmability was maintained by developing and applying a structured interview guide consistently across all participants, minimizing interviewer bias and ensuring that responses reflected participants’ perspectives. Transferability was supported by providing detailed descriptions of the study setting, participant characteristics, and methodological procedures, allowing readers to judge the applicability of the findings to other low-resource healthcare contexts. Dependability was ensured by using a standardized interview protocol, which maintained consistency across interviews and reduced variability in responses. These strategies collectively strengthened the rigor of the study and ensured that the findings were robust, reliable, and grounded in participants’ accounts. Data analysis The data analysis followed Braun and Clarke's thematic analysis approach( 17 ). Firstly, the researcher familiarized with the transcripts and examined each word to discern keywords, quotes, and initial themes. Development of inductive codes and composition of the thick description followed. Upon finalizing the code structure, it was systematically applied to all transcripts. The codes were categorized into themes. Throughout the analytical process, any newly identified codes were incorporated. Finally, findings were interpreted within thematic areas, and key lessons learned were documented. The analysis was done on the Swahili transcripts to maintain data integrity and enhance the quality of findings, and only direct translation to English was done on the quotations included in the article. Results A total of nine health care workers involved directly at the cervical cancer screening program and their supervisors were interviewed. These included nurses and Assistant Medical Officers with varying experience in cervical cancer screening as shown in Table 1 . The ages of participants ranged from 49 to 59 years, with all being female. More than half of the key informants had worked in the cervical cancer screening program for eight years or more and there was also representation from providers with as little as one year of experience, ensuring a diversity of perspectives Social demographic characteristics of the study participants. Table 1 Social demographic characteristics of participants Participant (Key Informants) Age Educational / Professional background Years of experience in the cervical cancer screening program KII 1 50 Nursing Officer 8 years KII 2 55 Nursing Officer More than 10 KII 3 58 Assistant Medical Officer More than 8 KII 4 59 Nursing Officer 10 years KII 5 59 Nursing Officer 1 years KII 6 53 Nursing Officer 3 years KII 7 54 Nursing Officer More than 10 KII 8 49 Assistant Medical Officer 6 years KII 9 51 Nursing Officer 8 years Four major themes emerged from the data, reflecting the factors that influence implementation of the Screen-and-Treat Single Visit Approach (ST-SVA) in Ilala Municipal Council. These themes capture provider, client, and system-level issues that shape the delivery and quality of cervical cancer screening services. 1. Interpretation and Adaptation of Guideline • Inconsistent understanding of age eligibility In this study healthcare providers generally demonstrated awareness of the national cervical cancer screening guidelines, particularly the recommended age ranges for Visual Inspection with Acetic Acid (VIA). However, the knowledge of these age eligibility criteria varied considerably across individual providers. When asked to explain the age criteria some providers cited different screening ages than officially recommended. “ Because most of our clients are HIV positive so we screen anyone who has already engaged in sexual activities so you might find that even 17 years old are screened and this is up to 54. So, the age criteria for screening age starts from 18 till 54 but for those who have already started engaging in sexual activities we can start even before that.”- (KII 2) “Most time women who are more at risk start from 40 years and those who have conceived 4 times or 5 times but we educate even those with 20 years so that they may be aware because now days even young girls get cervical cancer” - (KII 5) Some providers expressed uncertainty about the official age criteria. “There is an age criterion I think it’s from 20 to 50 for VIA, but for HPV DNA it’s up to 60.” - (KII 1) • Clinical adaptation for high-risk groups Despite the variation in interpretation, most providers acknowledged the importance of adapting the guidelines to better reach high-risk populations. This included screening clients below the recommended age group if had a history of recurrent sexually transmitted infections (STIs), or had multiple sexual partners or engage in sexual activities. “Of course, screening is based on the guidelines which guide us to start screening at 25 to 50 years for VIA and 60 for HPV DNA. But although the cutoff age for screening is 25, we screen people at risk at an earlier age. By ‘at risk’ we mean those with recurrent STIs, multiple sexual partners - (KII 3) “Yes, there is a screening age criterion and before we used to stop screening at 50 but after introduction of the new test, we go till 60… and for the lower age we consider those who have already stated engaging with sexual activities... and through history taking you can tell if she has already started engaging with sexual activities” - (KII 8) 2. Client-Related Factors Affecting Treatment Uptake • Abstinence-related concerns When asking participants about factors that influence provision of same day treatment, they reported that client willingness to undergo treatment as one of the key determinants for same-day treatment. A commonly cited reason for unwillingness of clients to receive same-day treatment was the requirement for sexual abstinence during the post-treatment healing period. Participants reported that some women were unwilling to receive same day treatment due to the fact that they will have to abstain from sexual activities for a period of time after treatment, they requested to go back home first and discuss with their significant other and returned a later day for treatment after they have decided with their partners “This treatment is supposed to be same day but it depends on client’s willingness for example after screening and it is VIA positive before doing cryotherapy we counsel them. But the issues of abstinence is a big challenge if you tell a client that after treatment you will have to wait for a month and not engage in sexually issues, they can tell you wait first I have to go tell my partner but to some it fine they agree and we treat them on the same day” – (KII 2) • Fear of treatment In addition to abstinence-related concerns, participants identified fear of treatment as another barrier to same-day uptake. Women often expressed anxiety about undergoing cryotherapy, even after counseling. This fear was rooted in personal beliefs, community rumors, and misconceptions about the procedure. “Believes and fear, she tells you I am not ready you can try to counsel her to the maximum but she will still say I am not ready and you know this service depends on the willingness to the patient, so when she goes back home you try to trace her through phone calls but if she is not willing, she will not accept” - (KII 3) “the reason that I see mostly is most of them usually have fear, there are some who instill fear to others by telling them that the treatment is painful don’t go, and when we treat them they get surprised that those were all lies, you see people make up a lot of weird things in the streets like they tell them after treatment you won’t be able to walk but that’s not true and the treatment is simple “ - (KII 1) Peer and family influences Some of the participants also reported peer influence was also one of the reason clients refused treatment. Providers noted that while waiting for services, women would sometimes discourage each other from undergoing screening or treatment. “Some women are not ready because you may find the have already influenced each not to accept screening while they are at the waiting area...” – (KII 9) Family dynamics and misinformation further complicated adherence to the care pathway. Misinterpretation of diagnoses such as cervical lesions often led to further complicate the situation. “the way people perceive cancer is a problem, especially with families, when you tell the client that they have a small lesion or HPV the family assumes it cancer, they start telling her not to receive treatment they should find a witch doctor and scare her that she will receive radiation and die” – (KII 3) 3. Healthcare Provider Capacity and Readiness: • Mixed perceptions on training adequacy When asking participants concerning their competencies there were mixed responses like ambivalence in training of staff on cervical cancer screening. While some providers reported receiving substantial and structured training, others indicated they have never attended refresher courses since their initial instruction, which in some cases dated back more than a decade. “Of course, I have been trained a lot. I have been trained by the hospital which sent us to study issues of cervical cancer screening. And an advantage I have been trained also by Medical women Association Tanzania (MEWATA) because one of the goals of MEWATA is to prevent cervical and breast cancer. So, they trained me again that’s why I am very competent” – (KII 3) “ Well, on issues of training we have never gone for refresher training. We were only trained back in 2011/2012 on VIA and cryotherapy, although last year after HPV/DNA introduction one of the staff that we work with went.” – (KII 2) “I have never done official training but I did on job training and was taught here at work… here I only screen I haven’t yet gotten training on treatment but If I find a VIA positive client, I record in the registry and refer her to ... she is the one who does treatment competently” - (KII 6) • Staff Shortage Participant reported that there is a shortage staff to manage cervical cancer screening services effectively. In many facilities, only two or three staff members were designated for screening duties, and in practice, often only one was present in the screening room on any given day. “ The staff are really not enough, because in a room like this, you need at least two people. one for counseling, one for the procedure. Now I have to do both. The staff is not enough at all and it becamoes difficult to do everything.. Patients are many you might find the whole waiting area is full” – (KII 6) The situation gets more difficult when one trained staff member is unavailable due to illness, leave, or reassignment, forcing facilities to reassign personnel from other departments creating staffing gaps elsewhere. “we have a challenge in staff numbers for example If Dr.. gets sick and she is the person who does screening and treatment, we have to take someone else from another unit usually a nurse who’s trained, she comes and fill the gap but that creates a shortage in their original department.” – (KII 7) Loss of staff due to retirement or transfer without replacement further weaken the workforce. One provider described how a previously well-staffed unit had been reduced significantly, leaving remaining staff overwhelmed and unsupported. “ We used to have four people. Now two moved to other centers, one retired. We’re left with only two. If one is on leave, it creates a big gap .” – (KII 7) • Differential Follow-Up Systems When participants were asked on concerning one year follow up process of women who had received treatment. Healthcare providers consistently described a clear disparity in the follow-up systems for women living with HIV (PLHIV) compared to HIV-negative clients. Although they reported that all women are registered in the registry book with phone numbers and address, the processes that support their return for one-year follow-up differ markedly by HIV status. For women living with HIV providers highlighted strong coordination and communication among staff, with systematic file management and use of visual cues (such as stickers on files and CTC cards) to ensure that women due for cervical cancer follow-up are identified and reminded during their regular ART visits: “The good thing here regarding CECAP is that we really work as a team, from the reception to the last desk. If someone working in here in CTC checks and finds that a service is missing, they bring the case directly, no debate. The receptionist sorts the files and brings those for VIA screening to the VIA room. When a client is screened with VIA, we put a sticker on their file and also on their CTC card. So, the receptionist can easily know who has been screened, who need to rescreen, who is eligible, and who is due today, tomorrow, or next month.” - (KII 4) While for HIV negative women it was reported that their follow up is no linked to any structure clinical pathway but relies primary on their personal initiative. Although registers include phone numbers and places of origin to facilitate follow-up “ For those who are not CTC clients, they usually come to the hospital because they are sick, so they themselves tend to do follow-up because they want to know about their progress. However, in our registers, there is a section where you must fill in the phone number and the client’s place of origin” - (KII 2) Providers further explained that most HIV-negative women who receive treatment are referred from outside Dar es Salaam. After initial care, returning for follow-up is often not feasible: “ Most of them have come from outside Dar es Salaam. They have come to relatives who have convinced them to come test or they wanted to do test at Muhimbili hospital, but were denied until they get referral letter from other hospital because Muhimbili does not accept them without a referral. When they come, here OPD doctors recommends them for VIA, we find out it was a lesion and give cryotherapy treatment. So, returning this person back to Dar es Salaam is a bit difficult.” - (KII 9) 4. Availability of Equipment and Supplies • Donor Dependency for Essential Supplies Participants reported that another barrier to screening adherence is the availability of essential supplies such as speculums which depended heavily on on external donor support primarily from implementing partners such as MDH. When delays in donor procurement occurred, service is usually interrupted. “ There is an issue of availability of speculum and lately, here have been a shortage of speculum because we get all supplies from our donor (MDH) so when the donor delays a bit in supply it becomes a challenge because we use disposable speculums” - (KII 2) Some participants expressed concern that recent reductions in donor funding and shifting project priorities and fear funding collapsing. “I cannot say a lot on the issue of equipment because MDH are the one funding it and you know lately there have a shakedown on donor funding because in the beginning everything was available, they were very good, the project that deals with CTC clients offered a lot of equipment.” - (KII 5) “The challenges is in equipment like speculums which are brought by MDH who are the only implementing the project that why we are in shortage of speculum we can’t perform VIA… and Now it’s a challenges, it has become a challenge because the project is collapsing” - (KII 4) • Equipment functionality and maintenance Participant also reported that cryotherapy machines issues due to maintenances services affected the same day treatment at the facility leading them to referral women to other facility. “In terms of cryotherapy, gas is not a problem. We have a lot of gas at the facility and we if it gets replenished, we can request the car for refill. But the problem is with the cryotherapy machine itself because it doesn’t get regular maintenance so we have two cryotherapy machines but sometimes you might find the service period has passed so the machine starts to misbehave and you can’t do treatment so we refer them to the nearest facility. - (KII 2) Discussion The study revealed several factors that influence implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala MC Dar es Salaam. These factors span provider, client, and health system levels, highlighting the complexities involved in delivering effective cervical cancer screening services in low-resource urban settings. The findings are consistent with a growing body of evidence from low- and middle-income countries (LMICs), highlighting the critical role of workforce capacity, resource availability, structural systems, and policy environments in shaping implementation fidelity. Provider interpretation and adaptation of cervical cancer screening guidelines showed considerable variability, particularly concerning age eligibility criteria for Visual Inspection with Acetic Acid (VIA) screening. While most healthcare workers were aware of national recommendations, many adapted the guidelines based on client risk profiles, such as HIV status or sexual history. This finding aligns with previous studies from Ghana and other African contexts where providers modified screening criteria to reach high-risk populations outside official guidelines, balancing rigid protocols with clinical pragmatism( 18 , 19 ) Although such adaptations may increase detection among vulnerable groups, they underscore the need for clearer guideline dissemination and tailored training to ensure consistency and quality in implementation Client-related factors, including fear of treatment and concerns about post-treatment sexual abstinence, emerged as significant barriers to same-day treatment uptake. These findings reflect a broader pattern in sub-Saharan Africa, where misconceptions about cryotherapy's side effects and sociocultural norms around abstinence influence health-seeking behaviors ( 20 , 21 ). Peer and family influences further complicated treatment decisions, sometimes propagating stigma or misinformation about cervical lesions and cancer diagnoses. These results emphasize the importance of integrating community education and partner engagement into cervical cancer control strategies to address myths, support informed decision-making, and improve treatment adherence. Healthcare provider capacity and readiness were inconsistent, with mixed reports on training adequacy and frequent reliance on informal or outdated learning. Such gaps have been documented in Tanzania and neighboring countries, like in Ethiopia and Rwanda, where lack of comprehensive, hands-on training and frequent staff turnover resulted in inconsistent adherence to protocols and suboptimal diagnostic accuracy ( 8 , 9 ). In Kenya, high turnover of trained personnel and lack of ongoing professional development have been shown to disrupt continuity and quality of cryotherapy services( 22 ). Another persistent challenge was the availability of essential equipment and supplies which were reported to be heavily donor-dependent. Providers reported frequent stockouts of critical items such as speculums, and cited delays in maintenance of cryotherapy machines, which often disrupted the ability to provide timely screening and treatment. Similar dependencies and logistical challenges have been observed in other LMIC settings, undermining the reliability and sustainability of screen-and-treat programs ( 23 )These findings are also similar with studies from Kenya and Ethiopia, where supply chain interruptions and shortages of consumable materials were major barriers to protocol adherence( 9 , 22 ). Strengthening procurement systems, ensuring timely maintenance, and reducing donor dependency are vital strategies for improving the reliability of services. Structural and systemic barriers further compounded adherence challenges. These included inadequate clinical space for screening services and weak follow-up care. Similar barriers have been reported in Ethiopia, where limited supervision and inadequate infrastructure constrained provider performance, while improvements in these areas resulted in better adherence and service quality( 9 ). In Rwanda, challenges such as loss to follow-up and limited capacity for same-day treatment were also major obstacles to successful implementation( 8 ). These findings emphasize that high-quality cervical cancer screening programs require not only trained personnel and supplies, but also strong supervisory structures, efficient referral systems, and adequate physical infrastructure. Study Limitations This study has several limitations. First, it was conducted in only two facilities within Ilala Municipal Council, which may limit transferability to other regions of Tanzania. To mitigate this, we provided detailed descriptions of the study setting and context to enable readers to assess applicability to their own settings. Second, the perspectives explored were limited to healthcare providers, excluding clients and community members whose views could enrich understanding of barriers and facilitators. We sought to address this by interviewing providers from different cadres and levels of experience to capture diverse perspectives. Despite these limitations, the study offers valuable insights into the contextual factors shaping implementation of the screen-and-treat approach in an urban Tanzanian setting Conclusion This study demonstrates that the implementation of the screen-and-treat single-visit approach in Ilala is influenced by factors at the provider, client, and health system levels. Strengthening provider training, enhancing follow-up support for women, and ensuring reliable and sustainable supply chains are essential steps to improve the effectiveness and sustainability of cervical cancer prevention efforts in Tanzania. Abbreviations CECAP Cervical Cancer Prevention Program, HIV Human Immunodeficiency Virus LEEP Loop Electrosurgical Excision Procedure LMICs Low and Middle-Income Countries MoH Ministry of Health ST Screen and Treat STIs Sexually Transmitted Infections ST SVA Screen and Treat – Single Visit Approach SVA Single Visit Approach VIA Visual Inspection with Acetic Acid WHO World Health Organization Declarations Acknowledgment The authors acknowledge the support from the health care providers from the regional Amana Reginal Referral hospital and Mnazi Mmoja hospitals in Dar es Salaam. Also, the authors would like to acknowledge all the study participants for contributing to realizing this study and its results. Authors’ contributions LK conceived and designed the study, collected and analyzed the data, and drafted the manuscript. GRM and ATK provided overall supervision from conceptualization methodological guidance, and critical revisions of the manuscript. All authors read and approved the final version of the manuscript Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Availability of data and materials Availability of the datasets used and/or analyzed during the current study are available from the first author upon reasonable request. Ethical approval and consent to participate This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki(24). Ethical approval for this study was obtained from the Research and Publication Committee of Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board (IRB) with reference number Ref No. DA 282/298/01.C/2716). In line with the Declaration, participants were fully informed about the study’s purpose, procedures, and their rights. Written informed consent was obtained from all participants before data collection. To ensure privacy and confidentiality, no personally identifying information was collected, and all transcripts were anonymized using unique participant codes and securely stored. The study posed minimal risk as it involved professional reflections by healthcare providers rather than patient data or clinical interventions. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63. Accelerating the elimination. of cervical cancer as a public health problem: Towards achieving 90-70-90 targets by 2030. 2022 Jul. Global strategy to. accelerate the elimination of cervical cancer as a public health problem. World Health Organization; 2020. p. 52. 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BMC Infect Dis [Internet]. 2025 Dec 1 [cited 2025 Oct 14];25(1):1–12. Available from: https://bmcinfectdis.biomedcentral.com/articles/ 10.1186/s12879-025-10485-6 Mutyaba T, Mmiro FA, Weiderpass E. Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda. BMC Med Educ [Internet]. 2006 Mar 1 [cited 2025 Oct 14];6:13. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1413529/ Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health [Internet]. 2022 Dec 1 [cited 2025 Oct 14];22(1):1–20. Available from: https://bmcwomenshealth.biomedcentral.com/articles/ 10.1186/s12905-022-02043-y Ndejjo R, Mukama T, Musabyimana A, Musoke D. Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study. PLoS One [Internet]. 2016 Feb 1 [cited 2025 Oct 14];11(2):e0149696. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149696 Shin MB, Oluoch LM, Barnabas RV, Baynes C, Fridah H, Heitner J et al. Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services: a protocol for a stepped-wedge cluster randomized trial in Kenya. Implement Sci. 2023;18(1). Denny L, Quinn M, Sankaranarayanan R, Chapter. 8: Screening for cervical cancer in developing countries. Vaccine [Internet]. 2006 Aug 21 [cited 2025 Oct 15];24(SUPPL. 3):S71–7. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0264410X06007298 THE WORLD MEDICAL ASSOCIATION, INC. DECLARATION OF HELSINKI Ethical Principles for Medical Research Involving Human Subjects. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7982412","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":572553275,"identity":"d4259247-e40a-48c9-babb-25bc28bbb789","order_by":0,"name":"Ludovick Kessy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACPjBpwJDAxt4DZvLwEdLCBtfCc4aB4QBQCxtxWhgYEhgkcsBaGAhrkT5jJvGjwC6PT/Ltwccfc+xk2BiYHz66gU8LX46ZZI9BcjGbdF6ywcFtyUCHsRkb5+DTwsNjdoPH4EBim3SOmcTBbcxALTxs0oS03PwD0iJ5BqSlnjgtt8G2SPCAtBwmRgtb+W8Zg+TENp4cY4Oz247zsDET8As/D/Nmwzd/7BLnt58xfFC5rdqen7354WN8WrAAZtKUj4JRMApGwSjAAgDDZDyqcjtJQAAAAABJRU5ErkJggg==","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Ludovick","middleName":"","lastName":"Kessy","suffix":""},{"id":572553276,"identity":"25271189-d310-4f13-a400-ea4e846c7b5f","order_by":1,"name":"Gladys Reuben Mahiti","email":"","orcid":"","institution":"Muhimbili University of Health and Allied 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08:25:21","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85633,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7982412/v1/df77356fbe4420b7e44cf957.html"},{"id":100380974,"identity":"38b4633a-4d3f-4e68-b217-e638a815927a","added_by":"auto","created_at":"2026-01-16 10:36:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":879257,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7982412/v1/703d3844-10ed-4aea-b746-f9b8853745aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors influencing implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala Municipal Council, Dar es Salaam Tanzania: a qualitative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer is the fourth most common cancer among women globally, with 662,301 new cases and 348,874 deaths estimated in 2022(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Nearly 85% of these occur in low- and middle-income countries (LMICs), where limited access to preventive services contributes to late diagnosis and poor outcomes(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Tanzania, cervical cancer is the leading cause of cancer-related deaths among women, with approximately 10,868 new cases and 6,832 deaths annually(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePersistent infection with high-risk strains of human papillomavirus (HPV) is the main cause of cervical cancer(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Other risk factors include HIV infection, multiple sexual partners, high parity, and early sexual debut(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While the disease is preventable through HPV vaccination and screening for precancerous lesions, uptake of cervical cancer screening services in Tanzania remains low: According to the Tanzania demographic health survey only 7% of women have ever been screened(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), far below the World Health Organization (WHO) target of screening 70% of eligible women at least twice in their lifetime by 2030.\u003c/p\u003e \u003cp\u003eTo bridge this gap, Tanzania\u0026rsquo;s Ministry of Health adopted the Screen-and-Treat Single Visit Approach (ST-SVA). This model involves screening with Visual Inspection using Acetic Acid (VIA) and treating precancerous lesions on the same day using cryotherapy, thermal coagulation, or Loop Electrosurgical Excision Procedure (LEEP)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The single-visit design minimizes loss to follow-up and is more feasible in low-resource settings than cytology or HPV-based testing requiring multiple visits(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the ST-SVA has demonstrated effectiveness in reducing cervical cancer incidence in LMICs, its successful implementation depends on contextual factors at the health system, provider, and client levels. However, studies in sub-Saharan Africa suggest that its implementation is influenced by a range of provider, client, and system-level factors. These include limited provider training and refresher courses, stockouts of consumables, equipment failures, staff shortages, and weak follow-up mechanisms(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Furthermore, non-adherence to national screening guidelines, client fears and misconceptions, and dependence on donor support for supplies have been documented as barriers in similar contexts (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).While such barriers have been reported in countries like Ethiopia, Kenya, and Rwanda, there is limited evidence on how they shape implementation in Tanzania. Understanding these contextual influences is critical to strengthening prevention efforts and achieving national and global targets.\u003c/p\u003e \u003cp\u003eThis study therefore explores the factors influencing healthcare providers\u0026rsquo; implementation of the ST-SVA in Ilala Municipal Council, Dar es Salaam. The objective was to identify the factors influencing implementation of the ST-SVA in order to inform strategies for strengthening cervical cancer prevention in Tanzania.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Settings\u003c/h2\u003e \u003cp\u003eThe study engaged phenomenological design with semi structured key informant interviews as a data collection method owing to its usefulness in extracting information on a specific phenomenon (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The study was conducted at two high-volume health facilities in Ilala Municipal Council: Amana Referral Hospital and Mnazi Mnazi Hospitals both the Dar es Salaam Region:\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecruitment of participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePurposive sampling was used to recruit nine cervical cancer prevention program healthcare workers and administrative staff with varying levels of experience. This allowed for the intentional selection of individuals who had direct involvement in the program and provided valuable insights based on their specific roles and experiences(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Recruitment of participant continued until data saturation was achieved, ensuring that no new themes or information emerged(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eData collection.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSemi-structured Key informant interviews were conducted in Swahili between May and June 2025 by the first author (LK). The interview guide explored provider experiences with ST-SVA implementation, challenges faced, and perceptions of client and system-level influences. The interviews were conducted in Swahili, a language all the study participants spoke. Probing questions helped better understanding of the participants\u0026rsquo; opinions and experiences regarding the factors influencing. Interviews lasted 25\u0026ndash;35 minutes, were audio-recorded with consent. The audio-recorded files were transcribed verbatim and the transcripts were saved as Word files. To ensure the quality and accuracy of the transcripts, the authors reviewed the transcripts against the audio recordings before they were imported into the qualitative data management software (QS Nvivo version 14) for analysis\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrustworthiness\u003c/h3\u003e\n\u003cp\u003eTo ensure trustworthiness, the study applied the Guba criterions for qualitative rigor: credibility, confirmability, transferability, and dependability (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Credibility was enhanced by purposively selecting healthcare workers directly involved in the Screen-and-Treat Single Visit Approach (ST-SVA), ensuring that data reflected lived experiences. Findings were further validated through triangulation, where interview narratives were compared with field observations to strengthen reliability. Confirmability was maintained by developing and applying a structured interview guide consistently across all participants, minimizing interviewer bias and ensuring that responses reflected participants\u0026rsquo; perspectives. Transferability was supported by providing detailed descriptions of the study setting, participant characteristics, and methodological procedures, allowing readers to judge the applicability of the findings to other low-resource healthcare contexts. Dependability was ensured by using a standardized interview protocol, which maintained consistency across interviews and reduced variability in responses. These strategies collectively strengthened the rigor of the study and ensured that the findings were robust, reliable, and grounded in participants\u0026rsquo; accounts.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data analysis followed Braun and Clarke's thematic analysis approach(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Firstly, the researcher familiarized with the transcripts and examined each word to discern keywords, quotes, and initial themes. Development of inductive codes and composition of the thick description followed. Upon finalizing the code structure, it was systematically applied to all transcripts. The codes were categorized into themes. Throughout the analytical process, any newly identified codes were incorporated. Finally, findings were interpreted within thematic areas, and key lessons learned were documented. The analysis was done on the Swahili transcripts to maintain data integrity and enhance the quality of findings, and only direct translation to English was done on the quotations included in the article.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of nine health care workers involved directly at the cervical cancer screening program and their supervisors were interviewed. These included nurses and Assistant Medical Officers with varying experience in cervical cancer screening as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The ages of participants ranged from 49 to 59 years, with all being female. More than half of the key informants had worked in the cervical cancer screening program for eight years or more and there was also representation from providers with as little as one year of experience, ensuring a diversity of perspectives\u003c/p\u003e \u003cp\u003e \u003cb\u003eSocial demographic characteristics of the study participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocial demographic characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003cp\u003e(Key Informants)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducational / Professional background\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYears of experience in the cervical cancer screening program\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMore than 10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssistant Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMore than 8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMore than 10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssistant Medical Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKII 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFour major themes emerged from the data, reflecting the factors that influence implementation of the Screen-and-Treat Single Visit Approach (ST-SVA) in Ilala Municipal Council. These themes capture provider, client, and system-level issues that shape the delivery and quality of cervical cancer screening services.\u003c/p\u003e\n\u003ch3\u003e1. Interpretation and Adaptation of Guideline\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Inconsistent understanding of age eligibility\u003c/h2\u003e \u003cp\u003e In this study healthcare providers generally demonstrated awareness of the national cervical cancer screening guidelines, particularly the recommended age ranges for Visual Inspection with Acetic Acid (VIA). However, the knowledge of these age eligibility criteria varied considerably across individual providers. When asked to explain the age criteria some providers cited different screening ages than officially recommended.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eBecause most of our clients are HIV positive so we screen anyone who has already engaged in sexual activities so you might find that even 17 years old are screened and this is up to 54. So, the age criteria for screening age starts from 18 till 54 but for those who have already started engaging in sexual activities we can start even before that.\u0026rdquo;-\u003c/em\u003e (KII 2)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Most time women who are more at risk start from 40 years and those who have conceived 4 times or 5 times but we educate even those with 20 years so that they may be aware because now days even young girls get cervical cancer\u0026rdquo; -\u003c/em\u003e (KII 5)\u003c/p\u003e \u003cp\u003eSome providers expressed uncertainty about the official age criteria.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is an age criterion I think it\u0026rsquo;s from 20 to 50 for VIA, but for HPV DNA it\u0026rsquo;s up to 60.\u0026rdquo;\u003c/em\u003e - (KII 1)\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e• Clinical adaptation for high-risk groups\u003c/h3\u003e\n\u003cp\u003e Despite the variation in interpretation, most providers acknowledged the importance of adapting the guidelines to better reach high-risk populations. This included screening clients below the recommended age group if had a history of recurrent sexually transmitted infections (STIs), or had multiple sexual partners or engage in sexual activities.\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;Of course, screening is based on the guidelines which guide us to start screening at 25 to 50 years for VIA and 60 for HPV DNA. But although the cutoff age for screening is 25, we screen people at risk at an earlier age. By \u0026lsquo;at risk\u0026rsquo; we mean those with recurrent STIs, multiple sexual partners\u003c/em\u003e - (KII 3)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, there is a screening age criterion and before we used to stop screening at 50 but after introduction of the new test, we go till 60\u0026hellip; and for the lower age we consider those who have already stated engaging with sexual activities... and through history taking you can tell if she has already started engaging with sexual activities\u0026rdquo;\u003c/em\u003e - (KII 8)\u003c/p\u003e\n\u003ch3\u003e2. Client-Related Factors Affecting Treatment Uptake\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Abstinence-related concerns\u003c/h2\u003e \u003cp\u003eWhen asking participants about factors that influence provision of same day treatment, they reported that client willingness to undergo treatment as one of the key determinants for same-day treatment. A commonly cited reason for unwillingness of clients to receive same-day treatment was the requirement for sexual abstinence during the post-treatment healing period. Participants reported that some women were unwilling to receive same day treatment due to the fact that they will have to abstain from sexual activities for a period of time after treatment, they requested to go back home first and discuss with their significant other and returned a later day for treatment after they have decided with their partners\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;This treatment is supposed to be same day but it depends on client\u0026rsquo;s willingness for example after screening and it is VIA positive before doing cryotherapy we counsel them. But the issues of abstinence is a big challenge if you tell a client that after treatment you will have to wait for a month and not engage in sexually issues, they can tell you wait first I have to go tell my partner but to some it fine they agree and we treat them on the same day\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 2)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Fear of treatment\u003c/h2\u003e \u003cp\u003eIn addition to abstinence-related concerns, participants identified fear of treatment as another barrier to same-day uptake. Women often expressed anxiety about undergoing cryotherapy, even after counseling. This fear was rooted in personal beliefs, community rumors, and misconceptions about the procedure.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Believes and fear, she tells you I am not ready you can try to counsel her to the maximum but she will still say I am not ready and you know this service depends on the willingness to the patient, so when she goes back home you try to trace her through phone calls but if she is not willing, she will not accept\u0026rdquo;\u003c/em\u003e - (KII 3)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;the reason that I see mostly is most of them usually have fear, there are some who instill fear to others by telling them that the treatment is painful don\u0026rsquo;t go, and when we treat them they get surprised that those were all lies, you see people make up a lot of weird things in the streets like they tell them after treatment you won\u0026rsquo;t be able to walk but that\u0026rsquo;s not true and the treatment is simple \u0026ldquo;\u003c/em\u003e - (KII 1)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePeer and family influences\u003c/h2\u003e \u003cp\u003eSome of the participants also reported peer influence was also one of the reason clients refused treatment. Providers noted that while waiting for services, women would sometimes discourage each other from undergoing screening or treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some women are not ready because you may find the have already influenced each not to accept screening while they are at the waiting area...\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 9)\u003c/p\u003e \u003cp\u003eFamily dynamics and misinformation further complicated adherence to the care pathway. Misinterpretation of diagnoses such as cervical lesions often led to further complicate the situation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;the way people perceive cancer is a problem, especially with families, when you tell the client that they have a small lesion or HPV the family assumes it cancer, they start telling her not to receive treatment they should find a witch doctor and scare her that she will receive radiation and die\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 3)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3. Healthcare Provider Capacity and Readiness:\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; Mixed perceptions on training adequacy\u003c/h2\u003e \u003cp\u003eWhen asking participants concerning their competencies there were mixed responses like ambivalence in training of staff on cervical cancer screening. While some providers reported receiving substantial and structured training, others indicated they have never attended refresher courses since their initial instruction, which in some cases dated back more than a decade.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Of course, I have been trained a lot. I have been trained by the hospital which sent us to study issues of cervical cancer screening. And an advantage I have been trained also by Medical women Association Tanzania (MEWATA) because one of the goals of MEWATA is to prevent cervical and breast cancer. So, they trained me again that\u0026rsquo;s why I am very competent\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 3)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWell, on issues of training we have never gone for refresher training. We were only trained back in 2011/2012 on VIA and cryotherapy, although last year after HPV/DNA introduction one of the staff that we work with went.\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 2)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have never done official training but I did on job training and was taught here at work\u0026hellip; here I only screen I haven\u0026rsquo;t yet gotten training on treatment but If I find a VIA positive client, I record in the registry and refer her to ... she is the one who does treatment competently\u0026rdquo;\u003c/em\u003e - (KII 6)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Staff Shortage\u003c/h2\u003e \u003cp\u003eParticipant reported that there is a shortage staff to manage cervical cancer screening services effectively. In many facilities, only two or three staff members were designated for screening duties, and in practice, often only one was present in the screening room on any given day.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eThe staff are really not enough, because in a room like this, you need at least two people. one for counseling, one for the procedure. Now I have to do both. The staff is not enough at all and it becamoes difficult to do everything.. Patients are many you might find the whole waiting area is full\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 6)\u003c/p\u003e \u003cp\u003eThe situation gets more difficult when one trained staff member is unavailable due to illness, leave, or reassignment, forcing facilities to reassign personnel from other departments creating staffing gaps elsewhere.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;we have a challenge in staff numbers for example If Dr.. gets sick and she is the person who does screening and treatment, we have to take someone else from another unit usually a nurse who\u0026rsquo;s trained, she comes and fill the gap but that creates a shortage in their original department.\u0026rdquo;\u003c/em\u003e \u0026ndash; (KII 7)\u003c/p\u003e \u003cp\u003eLoss of staff due to retirement or transfer without replacement further weaken the workforce. One provider described how a previously well-staffed unit had been reduced significantly, leaving remaining staff overwhelmed and unsupported.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe used to have four people. Now two moved to other centers, one retired. We\u0026rsquo;re left with only two. If one is on leave, it creates a big gap\u003c/em\u003e.\u0026rdquo; \u0026ndash; (KII 7)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Differential Follow-Up Systems\u003c/h2\u003e \u003cp\u003eWhen participants were asked on concerning one year follow up process of women who had received treatment. Healthcare providers consistently described a clear disparity in the follow-up systems for women living with HIV (PLHIV) compared to HIV-negative clients. Although they reported that all women are registered in the registry book with phone numbers and address, the processes that support their return for one-year follow-up differ markedly by HIV status. For women living with HIV providers highlighted strong coordination and communication among staff, with systematic file management and use of visual cues (such as stickers on files and CTC cards) to ensure that women due for cervical cancer follow-up are identified and reminded during their regular ART visits:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The good thing here regarding CECAP is that we really work as a team, from the reception to the last desk. If someone working in here in CTC checks and finds that a service is missing, they bring the case directly, no debate. The receptionist sorts the files and brings those for VIA screening to the VIA room. When a client is screened with VIA, we put a sticker on their file and also on their CTC card. So, the receptionist can easily know who has been screened, who need to rescreen, who is eligible, and who is due today, tomorrow, or next month.\u0026rdquo;\u003c/em\u003e - (KII 4)\u003c/p\u003e \u003cp\u003eWhile for HIV negative women it was reported that their follow up is no linked to any structure clinical pathway but relies primary on their personal initiative. Although registers include phone numbers and places of origin to facilitate follow-up\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eFor those who are not CTC clients, they usually come to the hospital because they are sick, so they themselves tend to do follow-up because they want to know about their progress. However, in our registers, there is a section where you must fill in the phone number and the client\u0026rsquo;s place of origin\u0026rdquo;\u003c/em\u003e - (KII 2)\u003c/p\u003e \u003cp\u003eProviders further explained that most HIV-negative women who receive treatment are referred from outside Dar es Salaam. After initial care, returning for follow-up is often not feasible:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMost of them have come from outside Dar es Salaam. They have come to relatives who have convinced them to come test or they wanted to do test at Muhimbili hospital, but were denied until they get referral letter from other hospital because Muhimbili does not accept them without a referral. When they come, here OPD doctors recommends them for VIA, we find out it was a lesion and give cryotherapy treatment. So, returning this person back to Dar es Salaam is a bit difficult.\u0026rdquo;\u003c/em\u003e - (KII 9)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4. Availability of Equipment and Supplies\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; Donor Dependency for Essential Supplies\u003c/h2\u003e \u003cp\u003eParticipants reported that another barrier to screening adherence is the availability of essential supplies such as speculums which depended heavily on on external donor support primarily from implementing partners such as MDH. When delays in donor procurement occurred, service is usually interrupted.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eThere is an issue of availability of speculum and lately, here have been a shortage of speculum because we get all supplies from our donor (MDH) so when the donor delays a bit in supply it becomes a challenge because we use disposable speculums\u0026rdquo;\u003c/em\u003e - (KII 2)\u003c/p\u003e \u003cp\u003eSome participants expressed concern that recent reductions in donor funding and shifting project priorities and fear funding collapsing.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I cannot say a lot on the issue of equipment because MDH are the one funding it and you know lately there have a shakedown on donor funding because in the beginning everything was available, they were very good, the project that deals with CTC clients offered a lot of equipment.\u0026rdquo;\u003c/em\u003e - (KII 5)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The challenges is in equipment like speculums which are brought by MDH who are the only implementing the project that why we are in shortage of speculum we can\u0026rsquo;t perform VIA\u0026hellip; and Now it\u0026rsquo;s a challenges, it has become a challenge because the project is collapsing\u0026rdquo;\u003c/em\u003e - (KII 4)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; Equipment functionality and maintenance\u003c/h2\u003e \u003cp\u003eParticipant also reported that cryotherapy machines issues due to maintenances services affected the same day treatment at the facility leading them to referral women to other facility.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In terms of cryotherapy, gas is not a problem. We have a lot of gas at the facility and we if it gets replenished, we can request the car for refill. But the problem is with the cryotherapy machine itself because it doesn\u0026rsquo;t get regular maintenance so we have two cryotherapy machines but sometimes you might find the service period has passed so the machine starts to misbehave and you can\u0026rsquo;t do treatment so we refer them to the nearest facility. -\u003c/em\u003e (KII 2)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study revealed several factors that influence implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala MC Dar es Salaam. These factors span provider, client, and health system levels, highlighting the complexities involved in delivering effective cervical cancer screening services in low-resource urban settings. The findings are consistent with a growing body of evidence from low- and middle-income countries (LMICs), highlighting the critical role of workforce capacity, resource availability, structural systems, and policy environments in shaping implementation fidelity.\u003c/p\u003e \u003cp\u003e Provider interpretation and adaptation of cervical cancer screening guidelines showed considerable variability, particularly concerning age eligibility criteria for Visual Inspection with Acetic Acid (VIA) screening. While most healthcare workers were aware of national recommendations, many adapted the guidelines based on client risk profiles, such as HIV status or sexual history. This finding aligns with previous studies from Ghana and other African contexts where providers modified screening criteria to reach high-risk populations outside official guidelines, balancing rigid protocols with clinical pragmatism(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Although such adaptations may increase detection among vulnerable groups, they underscore the need for clearer guideline dissemination and tailored training to ensure consistency and quality in implementation\u003c/p\u003e \u003cp\u003eClient-related factors, including fear of treatment and concerns about post-treatment sexual abstinence, emerged as significant barriers to same-day treatment uptake. These findings reflect a broader pattern in sub-Saharan Africa, where misconceptions about cryotherapy's side effects and sociocultural norms around abstinence influence health-seeking behaviors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Peer and family influences further complicated treatment decisions, sometimes propagating stigma or misinformation about cervical lesions and cancer diagnoses. These results emphasize the importance of integrating community education and partner engagement into cervical cancer control strategies to address myths, support informed decision-making, and improve treatment adherence.\u003c/p\u003e \u003cp\u003eHealthcare provider capacity and readiness were inconsistent, with mixed reports on training adequacy and frequent reliance on informal or outdated learning. Such gaps have been documented in Tanzania and neighboring countries, like in Ethiopia and Rwanda, where lack of comprehensive, hands-on training and frequent staff turnover resulted in inconsistent adherence to protocols and suboptimal diagnostic accuracy (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Kenya, high turnover of trained personnel and lack of ongoing professional development have been shown to disrupt continuity and quality of cryotherapy services(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother persistent challenge was the availability of essential equipment and supplies which were reported to be heavily donor-dependent. Providers reported frequent stockouts of critical items such as speculums, and cited delays in maintenance of cryotherapy machines, which often disrupted the ability to provide timely screening and treatment. Similar dependencies and logistical challenges have been observed in other LMIC settings, undermining the reliability and sustainability of screen-and-treat programs (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)These findings are also similar with studies from Kenya and Ethiopia, where supply chain interruptions and shortages of consumable materials were major barriers to protocol adherence(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Strengthening procurement systems, ensuring timely maintenance, and reducing donor dependency are vital strategies for improving the reliability of services.\u003c/p\u003e \u003cp\u003eStructural and systemic barriers further compounded adherence challenges. These included inadequate clinical space for screening services and weak follow-up care. Similar barriers have been reported in Ethiopia, where limited supervision and inadequate infrastructure constrained provider performance, while improvements in these areas resulted in better adherence and service quality(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Rwanda, challenges such as loss to follow-up and limited capacity for same-day treatment were also major obstacles to successful implementation(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These findings emphasize that high-quality cervical cancer screening programs require not only trained personnel and supplies, but also strong supervisory structures, efficient referral systems, and adequate physical infrastructure.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, it was conducted in only two facilities within Ilala Municipal Council, which may limit transferability to other regions of Tanzania. To mitigate this, we provided detailed descriptions of the study setting and context to enable readers to assess applicability to their own settings. Second, the perspectives explored were limited to healthcare providers, excluding clients and community members whose views could enrich understanding of barriers and facilitators. We sought to address this by interviewing providers from different cadres and levels of experience to capture diverse perspectives. Despite these limitations, the study offers valuable insights into the contextual factors shaping implementation of the screen-and-treat approach in an urban Tanzanian setting\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that the implementation of the screen-and-treat single-visit approach in Ilala is influenced by factors at the provider, client, and health system levels. Strengthening provider training, enhancing follow-up support for women, and ensuring reliable and sustainable supply chains are essential steps to improve the effectiveness and sustainability of cervical cancer prevention efforts in Tanzania.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCECAP Cervical Cancer Prevention Program,\u003c/p\u003e \u003cp\u003eHIV Human Immunodeficiency Virus\u003c/p\u003e \u003cp\u003eLEEP Loop Electrosurgical Excision Procedure\u003c/p\u003e \u003cp\u003eLMICs Low and Middle-Income Countries\u003c/p\u003e \u003cp\u003eMoH Ministry of Health\u003c/p\u003e \u003cp\u003eST Screen and Treat\u003c/p\u003e \u003cp\u003eSTIs Sexually Transmitted Infections\u003c/p\u003e \u003cp\u003eST SVA Screen and Treat \u0026ndash; Single Visit Approach\u003c/p\u003e \u003cp\u003eSVA Single Visit Approach\u003c/p\u003e \u003cp\u003eVIA Visual Inspection with Acetic Acid\u003c/p\u003e \u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support from the health care providers from the regional Amana Reginal Referral hospital and Mnazi Mmoja hospitals in Dar es Salaam. Also, the authors would like to acknowledge all the study participants for contributing to realizing this study and its results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLK conceived and designed the study, collected and analyzed the data, and drafted the manuscript. GRM and ATK provided overall supervision from conceptualization methodological guidance, and critical revisions of the manuscript. All authors read and approved the final version of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of the datasets used and/or analyzed during the current study are available from the first author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki(24). Ethical approval for this study was obtained from the Research and Publication Committee of Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board (IRB) with reference number Ref No. DA 282/298/01.C/2716). In line with the Declaration, participants were fully informed about the study\u0026rsquo;s purpose, procedures, and their rights. Written informed consent was obtained from all participants before data collection. To ensure privacy and confidentiality, no personally identifying information was collected, and all transcripts were anonymized using unique participant codes and securely stored. The study posed minimal risk as it involved professional reflections by healthcare providers rather than patient data or clinical interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/S0264410X06007298\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/S0264410X06007298\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTHE WORLD MEDICAL ASSOCIATION, INC. DECLARATION OF HELSINKI Ethical Principles for Medical Research Involving Human Subjects.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, Screen-and-Treat, Single Visit Approach, Implementation","lastPublishedDoi":"10.21203/rs.3.rs-7982412/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7982412/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCervical cancer is a leading cause of cancer-related deaths among women in Tanzania. To address this burden, the Ministry of Health adopted the Screen-and-Treat Single Visit Approach (ST-SVA), which involves screening with Visual Inspection using Acetic Acid (VIA) and providing same-day treatment for precancerous lesions. Despite its effectiveness, little is known about the factors influencing its implementation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A qualitative phenomenological design was employed to two health facilities that is Mnazi Moja Hospital and Amana Regional Referral Hospitals in Ilala Municipal Council, Dar es Salaam. Nine healthcare providers were purposively selected and interviewed using semi structured interview guides. Data were analyzed thematically, with the support of NVivo 14 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study identified four key factors affecting the implementation of the screen-and-treat approach. Providers demonstrated varied interpretations of screening guidelines, sometimes extending services to younger women considered at higher risk. Women\u0026rsquo;s acceptance of same-day treatment was shaped by post-treatment abstinence requirements, fears and misconceptions about procedures, and the influence of peers or family members. Service delivery was further constrained by limited refresher training, staff shortages, and reliance on on-the-job learning. In addition, dependence on donor support and frequent equipment breakdowns disrupted continuity of services.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study demonstrates that the implementation of the screen-and-treat single-visit approach in Ilala is influenced by factors at the provider, client, and health system levels. Strengthening provider training, enhancing follow-up support for women, and ensuring reliable and sustainable supply chains are essential steps to improve the effectiveness and sustainability of cervical cancer prevention efforts in Tanzania.\u003c/p\u003e","manuscriptTitle":"Factors influencing implementation of the screen-and-treat single-visit approach for cervical cancer screening in Ilala Municipal Council, Dar es Salaam Tanzania: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 08:25:15","doi":"10.21203/rs.3.rs-7982412/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-21T05:58:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T13:23:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T20:45:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T14:56:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197089696849119515643439805244957896459","date":"2026-03-16T18:39:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5808826364842655117328095789322569679","date":"2026-03-13T18:02:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215506003478228518024232243485680947281","date":"2026-03-12T11:36:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64200533280467291640308121312025268791","date":"2026-01-10T15:51:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T12:44:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-04T18:25:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-03T18:41:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-11-03T18:38:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"395b28de-4861-4b97-a8bb-72e875d16b7e","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T07:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 08:25:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7982412","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7982412","identity":"rs-7982412","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}