Background:The IARC Public Health Decision Science Team (PHDS) has established a Center of Excellence (CHRONOS) to monitor the impact of human papillomavirus (HPV) vaccination in low- and middle-income countries (LMICs). The CHRONOS project aims to provide supervision, standardized documentation, and knowledge transfer tools that can be adapted to local specific contexts of LMICs, so that these countries can plan, prepare, conduct, monitor, and analyse cross-sectional surveys of age- and type-specific HPV prevalence.

Objectives:A core objective of CHRONOS is to develop and disseminate a comprehensive set of standardized tools to promote effective knowledge transfer and strengthen local capacity for monitoring the impact of HPV vaccination while remaining easily adaptable to highly specific local contexts. Collectively, these tools will support high-quality standards for the design, planning, and execution of HPV prevalence surveys, enabling methodological consistency across different settings worldwide.
 
Methods:Over the past two decades, IARC has conducted more than 30 HPV prevalence surveys in low- and middle-income countries, collecting cervical and urine specimens from sexually active women. Drawing on this extensive experience, IARC has developed a set of standardized tools covering the implementation of survey studies from planning to data analysis. The current version of the standardized documentation is being revised and pilot-tested in three countries—Bangladesh, Eswatini, and Indonesia. This pilot phase is designed to assess the effectiveness, robustness, and usability of the materials and to refine them into user-friendly templates, facilitating straightforward implementation by CHRONOS participating countries.

Results:Pilot testing of knowledge transfer using the standardized CHRONOS documentation and tools began in April 2025 and is currently being conducted and monitored in four phases, both remotely and on-site. In the first phase, protocol development, the CHRONOS Reference Book - a meta-document for study investigators and coordinators - guides the adaptation of the CHRONOS Study Protocol. It has been made available to all pilot countries, all of which have adapted the protocol and submitted it to their respective ethics committees. The second phase, implementation tools, involves the CHRONOS Study Implementation Manual -developed for local coordinators and field and laboratory managers- which is currently being used to generate detailed operational plans at study sites. The third phase, field and laboratory support, ensures fidelity of study execution by translating operational plans into user-friendly CHRONOS Standard Operating Procedures (SOPs) and Study Information Sheets. In parallel, the Laboratory Quality Assurance Plan is in place to maintain high-quality laboratory processes and will soon be applied by pilot country sites. Finally, the fourth phase, training documentation, involves the CHRONOS Study Implementation Teaching Toolkit, which supports in-person training of local staff to ensure adherence to protocols and SOPs.

Conclusions/Implications:The CHRONOS standardised documentation and tools have proven instrumental in the transfer of knowledge to the three CHRONOS pilot countries– Bangladesh, Eswatini, and Indonesia. These tools enable the implementation of HPV prevalence studies, the results of which are essential for informing local health policies, while simultaneously transferring the knowledge required to implement this type of study to local country coordination teams in low- and middle-income countries.