The OptiTri project aims to identify the most effective context-specific strategies for implementing cervical cancer screening using HPV testing among women living with HIV (WLHIV) in Cameroon. One strategy of the study involves offering participants a choice between two screening pathways: a two-visit pathway or a single-visit pathway. Shared decision-making (SDM) between professionals and participants was mobilized as a central component of this strategy to support informed choice of the care pathway.

Objectives
To examine the acceptability of the SDM among health professionals and WLHIV, to describe the design of the SDM, to analyze the compliance of its implementation.

Methods
A qualitative study was conducted between March 2025 and December 2025. In pre-implementation, we conducted individual interviews with midwives (n=2), WLHIV (n=7), psychosocial workers (n=5), and laboratory technicians (n=3), and held a one-day discussion workshop with health professionals, focusing on the organization of the SDM. The results served to design the SDM including the deliverers, the duration, the procedure. During implementation, we analyzed the SDM process through observations of the discussions between midwives and participants, and held a second workshop with midwives one month after implementation began. A thematic analysis was carried out.

Results
Pre-implementation, SDM was viewed by the midwives and the WLHIV as an important component of the choice-making, offering two main advantages: a participant-centered approach that fosters trust and ensures care aligned with women’s realities and preferences; and increased likelihood of screening completion through informed, voluntary choice of the screening pathway and greater accountability for the selected option. However, midwives anticipated an increase in workload due to the additional discussion with the participants. For WLHIV, interest for SDM was heterogeneous. Some felt able to participate in the decision-making, while others preferred to rely on the professionals’ opinions. These results helped inform the design of the SDM strategy, which would rely on psychosocial workers and midwives (with specific roles) for delivering it, with the support a decision aid tool.

Initial implementation showed that all 3 midwives participated in the SDM, with low engagement and low fidelity. They offered it in two stages: during group health education sessions and during the individual enrolment interview (approximately two minutes). This was done without using the decision aid tool, without covering all the points, and with an unbalanced presentation of the two options. The second workshop was conducted, leading to an increase in engagement of midwives and an increase in fidelity: SDM offered exclusively during the individual enrolment interview, in 10-15 minutes, using the decision aid tool, covering all intended points, and with a balanced presentation of the two options.

Conclusion/Implications for practice or policy
SDM is perceived an important element of the decision-making process, for an individual choice of the preferred and adapted cervical cancer screening pathway. Close attention and support are key to optimizing its implementation, by ensuring the compliance with established procedures. Further studies will be needed for analyzing the effects of the SDM on the choice of the screening pathway.