Table 4.

Relative comparison of tradeoffs across cervical cancer screening approaches for low- and middle-income countries included in the Cervical Precancer Planning Tool (CPPT)

		Benefits				Potential challenges
Screening approach	Description and pathway to treatment	Screening coverage for a fixed cost	Minimum clinic visits for screening	Option for self-sampling	Option for same-day treatment	Cases misseda	Overtreatment
VIA alone	A woman is screened with VIA (regular or enhanced). If positive, she is referred directly to treatment	Lowest	1b	No	Yes	High (will vary by provider)	High (will vary by provider)
HPV alonee	A woman is screened with an HPV test. If positive, she is referred to treatment without triage	Moderate	0c–1	Yes	Only with point of care HPV testingd	Lowest	Highest
HPV and VIA triage	A woman is screened with an HPV test. If positive, she is referred to a VIA triage test. If the triage test is positive, she is referred to treatment	Moderate	1c–2	Yes	Only with point of care HPV testingd	Highest	Low
HPV and enhanced triagef	Same as HPV & VIA triage, but the triage test is an enhanced/higher-quality test.f	Highestf	1c–2	Yes		Moderate	Lowest

^aMay be the most important metric if considering screening once in a lifetime

^bAssuming treatment is available on-site the day screening result is given to woman

^cAssumes HPV testing could be done with self-sampling

^dPoint of care diagnostic is typically defined as results within 15 min to 2 h (See further for the REASSURED criteria) [18]       

^eMeets WHO definition of “high-precision” [4] 

^fEnhanced triage options currently under evaluation; CPPT tool assumes enhanced triage should lead to a sensitivity and specificity of at least 80%, and/or an improvement of 20% over the baseline triage approach (VIA)