Table 1 A modified RE-AIM framework to evaluate community health campaign-based cervical cancer screening compared to health-facility based screening

Reach

Who is intended to benefit?

How do we reach reproductive-aged women in rural kenya?

A screening strategy offered through community health campaigns in a central location will reach a large proportion of reproductive-aged women.

How do we reach them?

Effectiveness

Is the program effective?

Are women getting screened for cervical cancer with HPV?

A community-based strategy allowing for self-testing will be highly acceptable.

How do we ensure effectiveness?

Are HPV + women successfully linking to treatment?

Innovative, patient and provider-designed strategies will increase the number of women linking to care.

Adoption and Maintenance

How can strategy be maintained after initial implementation and adopted in similar communities?

What are the patient, provider and delivery system processes necessary to ensure consistent service provision?

A screening protocol with a simple, patient-performed test offered as part of a health fair will minimize the costs to the health care system to introduce screening.

What are the short and long-term health effects in the community?

What is the population-level health impact of screening using HPV self-testing in the CHCs with enhanced linkage to care?

The high number of at -risk women reached through the CHC-base strategy with enhanced linkage to care would produce a greater population-level health impact.

Implementation

What is adherence to the implementation strategy at the delivery level?

Is HPV testing being offered and delivered consistently at the CHC and clinic sites?

Providing testing in a high-volume CHC will reach a large number of women with low staffing and infrastructure needs, and will therefore have a lower cost per woman treated than a standard strategy.

What are the costs of implementation?

What is the cost per lesion treated?