Towards cervical cancer elimination in Zambia: Stakeholder views on lessons learned, progress to date, and future needs and priorities.

Zambia has strived to reduce cervical cancer-related burden through screen-and-treat services for detection and treatment of precancerous lesions. Understanding health system barriers and opportunities could strengthen further scale-up. We conducted semi-structured interviews with 23 stakeholders working in different levels and roles. Interviews covered program organization; screen-and-treat, referrals, and linkages; and unmet needs. Interviews were audio-recorded, transcribed, and coded on key themes. National leadership, establishment of provincial focal points, and effective partnerships were seen as accomplishments, while reliance on donor resources was a major concern. Somewhat competing priorities emerged: scaling-up existing screen-and-treat v. ensuring screen-positive women receive treatment. Supply chain issues, screening with HPV DNA testing, task-shifting for treatment, and linkages to invasive cancer care were important themes. Despite challenges, stakeholders recognized notable progress scaling up screen-and-treat services. Given realities of budget constraints and donor dependency, relative prioritization of screen-and-treat scale-up vs. linkages to care should be deliberated and task-shifting considered.