The goal of this observational study is to focus on adapting and implementing a program to promote HPV and cervical cancer (CC) screening and follow-up treatment for HIV-positive women, with three specific aims:

• Adaptation: Use stakeholder deliberation to tailor the successful MoMent program for this population.
• Implementation and Assessment: Deploy the adapted MoMent program and evaluate its reach, effectiveness, adoption, and fidelity.
• Evaluation: Conduct a post-implementation process evaluation to identify barriers and facilitators to the program's maintenance and sustainability.

Despite the increased risk of cervical cancer (CC) among women living with HIV (WLWH), access to CC screening in Nigeria remains limited. While advances in prevention programs and antiretroviral therapy have reduced other AIDS-associated malignancies, CC risk in WLWH persists. This study aims to leverage Nigeria's existing HIV treatment infrastructure to integrate home-based CC (HCC) screening for WLWH.

The approach involves adapting the MoMent (MOther MENTor) peer-based HIV support program to include HCC screening and evaluating its implementation and sustainability using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM frameworks. The study has three key aims:

• Adapting the MoMent program to promote home-based HPV screening and follow-up treatment through stakeholder deliberation.
• Implementing and assessing the program's reach, effectiveness, adoption, and fidelity with a sample of 1,500 WLWH.
• Conducting a post-implementation evaluation to identify barriers and enablers for program maintenance and scalability.

Stakeholder input, including perspectives from WLWH, peer counselors, clinical managers, and policymakers, will guide the program's design and execution. By integrating stakeholder insights and addressing systemic challenges, the study aims to advance CC control in Nigeria and provide a scalable model for implementing cancer control strategies for people living with HIV in low- and middle-income countries globally.

Inclusion Criteria:

- Patients must be able to perform vaginal self-collection as well as give informed consent

Exclusion Criteria:

• Male gender
• Age <25 or >50
• Unknown or negative HIV status
• Pregnancy
• Hysterectomy
• Inability to give informed consent Inability/refusal to perform vaginal self-collection

Aim 1: The stakeholder deliberation conferences will include stakeholders from the following groups:

• State and National Policymakers
• Organizational-clinical managers
• Mentor mothers
• Women living with HIV (WLWH) Since this is a socio-behavioral component, pregnant individuals may partake. All individuals who take part in this portion of the study will be above 18 and capable of providing informed consent.

Aim 2: This study will only include WLWH aged 25-50. Pregnant individuals will not be included due to the potential for treatment of precancerous lesions. All individuals who partake in the study will be older than 18 and capable of providing informed consent.

Data shared:

De-identified sociodemographic data (e.g., race/ethnicity, age). Health behavior and health care utilization data from medical records. Cervical pathology results, HPV testing data, laboratory tests (e.g., CD4 and viral load), prescribed HIV medications, and adherence data.

Qualitative data from in-depth interviews and focus group discussions, coded and anonymized.

Start Date: After primary analyses have been completed and results are published (expected within 12 months of study completion).

End Date: Indefinitely, contingent on adherence to data-sharing agreements

Researchers will submit a Data Analysis Request Form, detailing their proposed analysis, purpose, and data needed.

Data access will be granted following review and approval. Approved users will sign a Data Use and Confidentiality Agreement. Anonymized data will be shared securely via a designated data repository or encrypted file transfer.

Researchers must commit to using the data for specified purposes, implementing secure data storage, and destroying or returning the data after analyses are completed.