OPTITRI

Cervical cancer is a major public health challenge in Cameroon, particularly among women living with HIV (WLHIV), who face a significantly higher risk of developing precancerous and cancerous cervical lesions. The OptiTri project, supported by an international consortium including Expertise France, ANRS, IRD, and the World Health Organization (WHO), in close collaboration with the Cameroonian Ministry of Public Health, aims to evaluate innovative strategies to optimize the cervical cancer screening cascade. This cascade spans from HPV testing to treatment of precancerous lesions using thermal ablation.

OptiTri adopts a multidisciplinary and integrated approach structured around three complementary pillars: optimization of care pathways (Large Centers and Small Centers studies), biological innovation (STRING study), and socio-anthropological research. The project promotes a multisectoral governance model through a local advisory committee involving health authorities, civil society organizations, and traditional and religious leaders. This ensures strong community engagement, local ownership, and long-term sustainability at the regional level. By integrating technological, biological, and social innovations, OptiTri aims to generate robust evidence to define effective, acceptable, and cost-efficient cervical cancer screening algorithms that can be scaled up nationally and across sub-Saharan Africa.

Principal Investigators: Dr. Joelle Sobngwi and Dr. Pierre DeBeaudrap

The OptiTri project aims to:

• Assess the implementation of cervical cancer screening before and after the introduction of differentiated service delivery strategies, focusing on acceptability, feasibility, adoption, and sustainability.
• Compare the effectiveness of two HPV-based cervical cancer screening strategies—centralized versus decentralized—to improve completion of the screening cascade.
• Evaluate the budgetary impact of cervical cancer screening with and without differentiated service delivery models.
• Document the lived experiences of women living with HIV and healthcare providers throughout screening and post-treatment follow-up.
• Assess the performance of different triage methods among HPV-positive women, including partial genotyping, visual inspection (with or without digital assistance), and S5 methylation biomarkers.
• Evaluate the diagnostic performance of HPV testing using urine samples.
• Assess the effectiveness of thermal ablation treatment in reducing the risk of post-treatment cervical lesions.

Optimization of Care Pathways (Large and Small Centers Studies) : In well-equipped hospital settings, the study evaluates the impact of a single-visit screening approach compared to differentiated service delivery models on follow-up completion. In under-resourced areas, a stepped-wedge trial compares centralized screening with decentralized screening using mobile health units. These models integrate artificial intelligence (AI)–assisted diagnosis using smartphone-based cervical imaging.

Biological Innovation (STRING Study) : This cross-sectional study evaluates less invasive screening methods, including urine-based HPV testing and DNA methylation biomarkers, to identify high-grade cervical lesions. The objective is to simplify and expand access to effective cervical cancer screening in low-resource settings.

Socio-Anthropological Research : An ethnographic approach explores social perceptions, healthcare provider–patient communication barriers, and the impact of cervical cancer screening on body image and sexuality among women living with HIV.

Effectiveness of the Cervical Cancer Care Cascade

Project success will be measured by the completeness of the screening cascade, defined as the proportion of HPV-positive women who complete all recommended screening and treatment steps. The single-visit approach is expected to significantly reduce loss to follow-up compared to multi-visit models. Mobile screening teams are anticipated to substantially increase coverage in remote and underserved areas compared to standard referral-based systems.

Validation of Artificial Intelligence for Cervical Cancer Screening

OptiTri aims to develop and validate a smartphone-based AI-assisted diagnostic app. High concordance between AI-supported diagnoses and expert assessments is expected. This innovation could empower nurses in rural settings to capture cervical images and receive immediate treatment recommendations, addressing the shortage of specialized physicians.

Innovation through the STRING Study

The STRING study seeks to validate innovative screening tools. Urine-based HPV testing is expected to demonstrate comparable diagnostic performance to cervical sampling, thereby improving cultural acceptability and screening uptake. Molecular methylation markers aim to precisely identify women at true risk, reducing unnecessary treatments.

Social Impact and Policy Recommendations

Socio-anthropological data will inform tailored health communication strategies by identifying fears, stigma, and sexual health concerns. Economic evaluations will determine the cost-effectiveness of each screening strategy to guide national budget allocation. Ultimately, the project will provide strong scientific evidence to support t

Expertise France & ANRS

Projet encore en cours d’implémentation.

The strength of the OptiTri project lies in its strong institutional anchoring and extensive partnership network. Under the leadership of the Cameroonian Ministry of Public Health, the project brings together leading academic, clinical, and financial stakeholders.

• Funding Partners: Expertise France (L’INITIATIVE) and ANRS
• Technical Partners: IRD, Inserm, IARC/WHO, EPFL, Queen Mary University of London, University of Dschang
• Local Implementation Partners: Yaoundé University Teaching Hospital (CHU), Centre Pasteur of Cameroon, CBCHS, and Simone Veil Hospital (Paris)

This multidisciplinary collaboration integrates expertise in virology, oncology, artificial intelligence, and social sciences to advance cervical cancer prevention among women living with HIV.