Cervical cancer remains a major public health challenge in low- and middle-income countries, reinforced by social inequalities, limited access to care, and the predominance of opportunistic screening models. In Pernambuco, Brazil, historically low cytology coverage and high loss to follow-up contributed to late-stage diagnoses, motivating a system-wide transition toward organized HPV-based screening aligned with the WHO elimination strategy.Objectives:To describe and evaluate the program design, pre-implementation strategy, and early operational results of the Uterus is Life (Útero é Vida) pilot phase to support national scale-up of organized HPV-based cervical cancer screening. We also aimed to characterize preparation, training, implementation, and monitoring activities across program pillars; identify implementation barriers and facilitators; and propose contingency actions to reduce interruptions in core operations. Methods : a cross-sectional descriptive evaluation of a population-based intervention in Pernambuco using a mixed-methods approach (quantitative and qualitative), focusing on the pre-implementation and early implementation phases of a phased transition toward organized screening based on high-risk HPV RT-PCR testing, standardized clinical algorithms, defined referral pathways for colposcopy and treatment, and integration of information systems. We analyzed program operational data from participating territories, structure–process–outcome indicators, semi-structured interviews, satisfaction and acceptability surveys among health teams and users, and external quality-control processes. Each new territory adopted a structured 12-week microplanning approach with on-site facilitators. Program development included: (1) assessment of opportunistic screening and care pathway redesign (2020–2021), service mapping, partnership building, training, and digital platform development; and (2) analytical and clinical validation of a national RT-PCR HPV test. In parallel, organized screening was implemented in priority municipalities using a commercially available validated high-risk HPV assay during the initial phase.Results: Between September 2023 and October 2025, 43,990 samples were collected for high-risk HPV DNA testing across priority implementation areas (22 municipalities and one additional territory), with results released within 15 days in 92.4% of tests. Samples were processed locally. Only 27 samples were unsatisfactory (<1%). Reflex cytology was performed as indicated, and 68.7% of reflex cytology results were normal. Screening and diagnostic work-up identified 416 high-risk lesions and 318 low-risk lesions, as well as 7 cases of invasive cervical cancer.The program operationalized five strategic pillars: governance/management; prevention and care; research and innovation; education; and information/communication, with progressive refinement of indicators and monitoring systems. Centralized and integrated data reduced registration gaps and loss to follow-up, supported timely corrective actions with municipalities, and improved visibility of territorial disparities. Digital tools combined with care navigation strengthened pathway traceability and coordination between primary care, diagnostic services, and specialized care, contributing to shorter time (1/3 at 1 y)to subsequent steps and expanded coverage.Conclusions and Implications:Early findings support the feasibility and acceptability of organized HPV-based screening within SUS when anchored in adaptive governance, territory-specific microplanning, continuous training, care navigation, and integrated digital monitoring. Persistent regional disparities in care flows reinforce the need for tailored implementation strategies and agreed contingency plans to sustain core operations. Long-term success will depend on ensuring the right intervention reaches the right populations, in the right places, with continuity and sustainability at scale.

Flowchart for cervical cancer screening using HPV testing. Uterus is Life Program, pilot project Brazil.