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Background: Despite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs’ perceptions of barriers and facilitators for women’s access to CC secondary prevention in Cochabamba, Bolivia.

Methods: Qualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque’s access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels.

Results: HCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal–community level, barriers included family-transferred misconceptions, gender norms, and women’s fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational–structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening.

Conclusions: HCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women’s lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.

Objectives. To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods. Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results. Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions. Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

Objetivos. Calcular las tasas de cobertura del tamizaje del cáncer cervicouterino y evaluar la distribución espacial y las agrupaciones de departamentos y municipios bolivianos.

Métodos. Se calcularon las tasas estandarizadas de cobertura con el método de estandarización directa. Se utilizó la prueba de la I de Moran global para determinar si había autocorrelación espacial en la cobertura, y se aplicó la prueba de la Gi* de Getis y Ord para encontrar posibles agrupaciones espaciales de municipios donde la cobertura fuese alta o baja.

Resultados. La cobertura general fue baja. En el 2022, en Bolivia se aplicó el tamizaje del cáncer cervicouterino a alrededor del 14% de las mujeres de entre 20 y 69 años. Se observan importantes inequidades geográficas en las tasas de cobertura tanto entre departamentos como entre municipios. A nivel municipal hay grandes diferencias, con valores que van del 59% a menos del 1%. Se observaron zonas de cobertura alta en el nordeste y el sudeste de Bolivia, concretamente en los departamentos de Pando, Chuquisaca y Tarija, mientras que las zonas de cobertura baja se ubicaban en los departamentos de Beni y Santa Cruz.

Conclusiones. Bolivia aún está muy lejos de alcanzar la meta de la Organización Mundial de la Salud de una cobertura del tamizaje del cáncer cervicouterino del 70%. Los presentes resultados indican dónde debe reforzarse el programa de tamizaje para mejorar la capacidad de respuesta del sistema de salud boliviano para atender las necesidades de salud reproductiva de las mujeres.

Objetivos. Estimar as taxas de cobertura do rastreamento do câncer do colo do útero e avaliar aglomerados e a distribuição espacial entre departamentos e municípios na Bolívia.

Métodos. Taxas padronizadas de cobertura do rastreamento do câncer do colo do útero foram calculadas por meio do método de padronização direta. Utilizou-se o índice I de Moran global para investigar a ocorrência de autocorrelação espacial na cobertura do rastreamento e estatística Getis-Ord Gi* para identificar aglomerados espaciais de municípios com cobertura alta (hot spot) ou baixa (cold spot).

Resultados. A cobertura geral foi considerada baixa. Aproximadamente 14% das mulheres de 20 a 69 anos realizaram o rastreamento na Bolívia em 2022. Foram constatadas grandes iniquidades geográficas nas taxas de cobertura do rastreamento do câncer do colo do útero, tanto entre os departamentos como entre os municípios. No nível municipal, o rastreamento apresentou enormes diferenças, variando de 59% a menos de 1%. Foram identificados hot spots no noroeste e no sudeste da Bolívia, especificamente nos departamentos de Chuquisaca, Pando e Tarija. Por outro lado, foram identificados cool spots nos departamentos de Beni e Santa Cruz.Conclusões. A Bolívia ainda está longe de alcançar a meta de 70% de cobertura do rastreamento estabelecida pela Organização Mundial da Saúde. Os resultados indicam áreas onde o programa de rastreamento precisa ser fortalecido para aprimorar a capacidade de resposta do sistema de saúde da Bolívia às necessidades de saúde reprodutiva das mulheres.