Background
Cervical cancer elimination requires adequate screening and treatment capacity, together with systems to monitor service delivery as cervical cancer prevention programmes expand. In South Africa, policy supports a transition to HPV-based screening and simplified screen–triage–treat pathways. However, laboratory services, specialist referral capacity, and routine monitoring systems remain unevenly distributed. These constraints limit scale-up, particularly in under resourced settings including high HIV-burden areas.
Objectives
To examine how cervical cancer screening and treatment capacity can be increased. The study evaluates a combined approach integrating existing laboratory infrastructure and mobile HPV screen–triage–treat services, supported by the development of a lightweight digital dashboard for routine programme oversight
Methods
A mixed-methods study was undertaken. Private-sector cytology and HPV testing capacity was mapped using a laboratory questionnaire to assess potential contributions to expanded cytology screening under National Health Insurance. Population-level cervical cytology data from the National Health Laboratory Service (NHLS) in Gauteng Province (2018–2022) were analysed to characterise screening activity and the proportion of tests with high-grade squamous intraepithelial lesions (HSIL). Operational and pathway-level costing compared traditional cytology–colposcopy referral with mobile HPV screen–triage–treat models. To support increased screening coverage, a lightweight digital monitoring system was developed for mobile services, using minimal routine data capture,  and real-time generation of aligned indicators.
Results
Private-sector laboratory mapping demonstrated substantial national capacity for cytology and HPV testing, concentrated in metropolitan areas  with geographic gaps in rural and peri-urban areas. NHLS data showed a sustained volume of detected HSIL results, with 70–78% occurring among women living with HIV. Costing analyses indicated that HPV-based screen–triage–treat pathways delivered via mobile platforms are substantially less costly than cytology–colposcopy referral pathways. A near-real-time digital monitoring system was developed to generate standardised indicators. The design incorporates offline data capture and automated validation to enable consistent real-time  reporting without increasing frontline workload as service capacity expands.
Conclusions / Implications for practice or policy
Increasing cervical cancer prevention capacity requires effective service delivery supported by routine monitoring. This study shows that combining existing laboratory capacity with mobile HPV screen–triage–treat delivery can expand access while reducing reliance on constrained referral systems. Embedding a lightweight monitoring system within service delivery strengthens programme oversight as capacity grows. Together, these approaches support implementation of HPV-based screening and align with WHO and IARC priorities for strengthening surveillance and accelerating progress toward cervical cancer elimination in South Africa.