Single-visit approaches (SVA) encompass a spectrum of cervical cancer prevention strategies designed to provide screening, diagnosis, and treatment during a single healthcare encounter. These approaches were developed to address the substantial loss to follow-up observed in conventional multi-visit screening programs and have become increasingly important in resource-constrained settings.

Table 1includes studies evaluating Single-Visit Approaches for Cervical Cancer Prevention in LMICs.

Table 1. Major studies evaluating single-visit approaches for cervical cancer prevention in LMICs.

Screen-and-Treat

The screen-and-treat approach involves immediate treatment of women who screen positive without prior histopathological confirmation [5][6]. Historically, visual inspection with acetic acid (VIA) has been the most widely used screening modality in such programs because results are available immediately. Women with positive VIA findings who meet eligibility criteria undergo same-day cryotherapy or thermal ablation [7].

More recently, HPV-based screen-and-treat strategies have emerged as the preferred model due to the superior sensitivity of HPV testing for detecting cervical precancer [8][9]. Point-of-care HPV testing has further strengthened this approach by enabling same-day treatment decisions [9].

See-and-Treat

See-and-treat approaches incorporate colposcopic evaluation before treatment [10][11]. Women with positive screening tests undergo colposcopy and receive immediate treatment if high-grade disease is suspected. This strategy reduces delays while providing greater diagnostic confidence than screen-and-treat models.

Although concerns regarding overtreatment remain, several studies have demonstrated acceptable overtreatment rates when careful patient selection and standardized colposcopic assessment are employed [10][11].

Emerging One-Screen Models

Advances in technology are transforming cervical cancer prevention. Emerging models combine:

HPV self-samplingPoint-of-care HPV testingAutomated visual evaluation (AVE)HPV-Automated Visual Evaluation (PAVE)Same-day thermal ablation

These innovations may allow effective cervical cancer prevention to be delivered through a single interaction with the healthcare system [12].

Evidence from South Africa

One of the most influential studies evaluating screen-and-treat strategies was conducted by Denny and colleagues in South Africa [13]. In this randomized controlled trial involving 6555 women, HPV-based screen-and-treat substantially reduced the prevalence of high-grade cervical lesions compared with delayed evaluation. VIA-based treatment also reduced disease burden, although to a lesser extent.

This landmark trial established proof-of-concept that immediate treatment following screening could effectively reduce cervical precancer.

Evidence from India

India has played a pivotal role in the development of evidence supporting single-visit approaches. Studies led by Sankaranarayanan and colleagues demonstrated the effectiveness of VIA- and HPV-based screening programs [14][15].

A cluster-randomized trial conducted in rural India showed a significant reduction in cervical cancer mortality among women offered VIA screening and treatment compared with unscreened populations [14]. These findings remain among the strongest demonstrations of the population-level impact of cervical cancer screening in LMICs.

Subsequent studies evaluated single-visit implementation models and demonstrated that VIA, colposcopy, biopsy, and immediate treatment could be integrated into a streamlined pathway [10][16].

Institutional experiences from tertiary care centers have further demonstrated the feasibility of same-day treatment pathways utilizing Swede score-guided management and thermal ablation. Emerging conference data suggest that integration of risk stratification tools may further improve treatment efficiency while minimizing overtreatment.

Evidence from Ethiopia

The Addis Tesfa project represents one of the most successful examples of SVA implementation among women living with HIV [17]. More than 16,000 women were counselled regarding cervical cancer prevention, and over 99% accepted screening.

Among screen-positive women, treatment completion exceeded 94%, highlighting the effectiveness of same-day treatment pathways in minimizing loss to follow-up. The Ethiopian experience also demonstrated the feasibility of nurse-led service delivery and integration of cervical cancer prevention into existing HIV care infrastructure [17].

Evidence from Indonesia

Indonesia has implemented one of the largest VIA-based single-visit programs. In a cross-sectional evaluation, 22,040 women completed screening, and 92.7% had never previously been screened [18].

The program demonstrated that large-scale implementation of VIA, biopsy, and same-day cryotherapy was feasible in a low-resource setting [18].

Evidence from Peru

Implementation work in the Peruvian Amazon introduced HPV testing, including self-sampling, followed by visual assessment and portable thermal ablation at the primary-care level across 17 facilities [19].

Within six months, screening rates increased and approximately 70% of HPV-positive women reached a completion-of-care endpoint, compared with about 30% before implementation [19].

Acceptability is a critical determinant of successful cervical cancer prevention programs. Evidence from multiple countries suggests that women generally prefer simplified care pathways that minimize the need for repeated clinic visits [20][21].

Table 2 states the benefits of same day single visit treatment.

Table 2. Benefits of single-visit approaches for women.

Thermal ablation or LLETZ may be provided on the same day when the lesion is eligible, appropriate infrastructure is available, and trained providers are present. Suspected invasive disease or lesions unsuitable for ablation require referral for diagnostic evaluation and excisional management [7][11].

Reported benefits include:

Reduced travel requirementsLower out-of-pocket expendituresLess time away from workReduced anxiety associated with waiting for resultsIncreased confidence in treatment completion

Studies evaluating thermal ablation have consistently demonstrated high patient satisfaction despite commonly reported transient pain, discharge, or bleeding [20][21].

Published Indian experience has similarly demonstrated high levels of patient acceptance, low pain scores, and few complications after thermal ablation [22].

HPV self-sampling may further expand access among under-screened women and is generally valued for privacy, convenience, and comfort [23].

Thermal Ablation: Expanding Access to Treatment

Thermal ablation has emerged as one of the most important innovations in cervical cancer prevention over the past decade.

Unlike cryotherapy, thermal ablation does not require refrigerant gas and can be delivered using portable devices. This makes it particularly suitable for outreach services, rural health facilities, and primary care settings [11][24].

The World Health Organization endorsed thermal ablation as a treatment option for cervical precancer in 2019 [11].

Evidence indicates that thermal ablation has treatment success broadly comparable to cryotherapy while offering operational advantages, and it can be performed by appropriately trained non-physician providers [11][24].

Published work from India has demonstrated excellent patient acceptability, low pain scores, and minimal complications [22].

As countries expand HPV-based screening, thermal ablation is likely to become increasingly important because of its simplicity and scalability.

Limitations of these approaches: Screen-and-treat may cause overtreatment when treatment is provided without histopathological confirmation or when screening specificity is limited. Potential harms include pain, bleeding, discharge, infection, and cervical stenosis; eligibility assessment is essential, and excisional treatment may have reproductive implications. Programs therefore require trained providers, appropriate treatment and referral facilities, follow-up, and quality assurance [7][11][20].

Workforce shortages remain a major challenge for cervical cancer prevention in LMICs. Many countries have insufficient numbers of gynecologists, colposcopists, and pathologists to support conventional screening programs.

Task-sharing has emerged as an effective strategy for addressing these limitations.

Nurses and midwives have successfully performed:

VIA screeningHPV sample collectionCryotherapyThermal ablationPatient counsellingFollow-up coordination

Implementation experience and guidance support task-sharing of screening and ablative treatment with appropriately trained nurses, midwives, and other non-physician providers [11][17][24].

Task-sharing offers several advantages:

Improved geographic coverageLower program costsEnhanced sustainabilityGreater integration into primary healthcare

Successful implementation requires standardized training, ongoing mentorship, and quality assurance systems.