Table 5. Model 3—Complex program of integration and coordination described.

Study	Study type	Setting	Model of care	Integration	Screening n (% of those offered)	HIV positive	Treatment coverage	Selection bias
McCree-Hale 2011	Case series	Urban HIV clinics, Tanzania	HIV clinics provide Pap smear screening, slides sent to lab in external hospital, follow-up and treatment at national cancer center.	CaCx screening integrated into HIV a clinics, using existing staff. Coordination with external center and lay health workers to ensure follow-up of care.	1,440	100%	Of the 124 women with SIL, 5 (4%) presented for follow up and treatment at the national cancer center. The remaining 119 women had to be tracked using a district tracking mechanism comprised of trained lay health workers.	N/A
Khozaim 2014	Retrospective descriptive study	Four regional HIV clinics and child-maternal clinics, Kenya	‘See and Treat’: VIA and cryotherapy. Cryotherapy-ineligible evaluated by local gynecologists at mobile colposcopy service rotating once a month per site, biopsies evaluated at referral hospital and results reviewed by gynecologists at the clinics, referred for LEEP.	Integration of a public sector CaCx screening program into existing large HIV clinics. MoH working with NGO to train local staff and implement system of care across 4 regions. The collaboration provide logistic support, supply chain management, and screening rooms.	6,787	NA	206 women underwent cryotherapy, 754 colposcopy, 143 LEEP, and 27 hysterectomy. The overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/ chemotherapy.	N/A
Plotkin 2014	Cross-sectional	Government health facilities: The national consultant referral hospital, two regional hospitals, twelve district hospitals, and six health centers, Tanzania	HIV: HIV testing offered to all women unless they were HIV positive or (self) reported being tested in the last three months. If test positive, referred to the onsite HIV CTC. CaCx: “See and Treat”: VIA and cryotherapy, advanced cases referred. Three the facilities also offered LEEP for treatment of large lesions.	Integration of HIV testing within newly introduced CaCx screening and treatment services, located in the reproductive and child health (RCH) section of the facility. Coordinated referral between RCH and HIV CTC. Part of the Government National Strategy for CaCx prevention.	24,966 for CaCx; 11,819 (94%) for HIV	NA	NA: Screening/testing only	Low/unclear
Mungo 2013	Retrospective record review- before and after study	Family AIDS Care and Education Services HIV clinic, Kenya	VIA and colposcopy, LEEP treatment, advanced cases referred. Women treated with LEEP were re-screened with colposcopy at 6, 12, and 24 months, and those with CIN 2, CIN 2/3, or stage IA1 disease during follow-up were offered repeat LEEP.	Addition of LEEP treatment to CaCx screening services at a HIV clinic. Coordination with external pathologist to interpret biopsies, in-clinic gynecologist for clinical staging, and external hospitals for treatment.	4,308	100%	100% (39/39) stage IA1 patients and 95.1% (39/41) of all women with ICC accessed treatment.	High
Pfaendler 2009	Cross-sectional	13 primary care clinics and a tertiary care hospital, Zambia	‘See and Treat’: VIA and cryotherapy. Referral of patients for further evaluation: repeat VIA and punch biopsy or LEEP, with 6-week follow-up. Further referral as necessary.	Implementation of a referral and management system for cryotherapy-ineligible women needing further evaluation. HIV peer educators, HIV CTC staff, and nurses engaged in community awareness for CaCx screening among HIV-positive women.	8,823	41.5%	2,378 women were treated with cryotherapy and 1,477 were referred. 59.2% (875) of women referred kept their appointments. 748 women underwent LEEP.	N/A
Shiferaw 2016	Cohort	14 tertiary and secondary-level health facilities (5 allocated as Centers of Excellence), Ethiopia	‘See and Treat’: VIA and cryotherapy, ineligible referred for LEEP at Centers of Excellence. Counselled to return for follow-up.	Integration of CaCx screening and treatment into the HIV and AIDS care and treatment package, establish provider teams throughout five regions, build capacity, and promoted community education and awareness. Coordinated referral and patient follow-up between ‘see and treat’ sites and Centers of Excellence.	16,632 (99.4%)	100%	96.9% (1,481) of eligible women received cryotherapy on the same day as screening; 63.0% (80) of women referred for LEEP received treatment; 51.1% (614) of women expected to come for follow-up returned for screening 1 year later and were screened.	N/A

Abbreviations: CaCx: cervical cancer, SIL: squamous intraepithelial lesion, VIA: visual inspection with acetic acid, LEEP: loop electrosurgical excision procedure, MoH: Ministry of Health, NGO: non-governmental organization, CTC: care and treatment centers, CIN: cervical intraepithelial neoplasia, NA: not applicable