PROJECT SUMMARY Delays and missed opportunities for timely treatment contribute significantly to disparities in cervical cancer mortality in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cervical cancer is one of the most common female cancers globally, with approximately 90% of cases and deaths occurring in LMICs, particularly those with high rates of HIV. This global disparity is partly driven by successful efforts in HICs to implement evidence-based practices focused on early detection and timeliness of care. In Botswana, a LMIC with an extremely high prevalence of HIV and cervical cancer, we identified substantial delays in cancer care from diagnosis to treatment, driven by a myriad of individual- and system-level barriers. To date, most of the implementation and cancer control research in Botswana and other LMICs has focused on prevention and screening, with limited focus on treatment following diagnosis of HIV-associated malignancies. As such, there is a critical need to identify effective strategies to ensure timely care, and to understand contextual factors that shape the response to strategies. Without this fundamental knowledge, cervical cancer will remain a public health crisis in Botswana and other LMICs. To help fill this critical gap, this study will test the effectiveness of adaptive strategies on timely treatment adoption using a Sequential Multiple Assignment Randomized Trial (SMART) design and evaluate contextual mechanisms contributing to the success or failure of each adaptive strategy using qualitative comparative analysis. The adaptive strategies are designed to target individual- and system-level determinants identified in our preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics, and are supported by systematic evidence of the effectiveness of nudge strategies in clinical care. The primary implementation outcome will be adoption, defined as the initiation of treatment within 90 days. Secondary implementation outcomes include fidelity (i.e., completion of recommended treatment), reach, acceptability, implementation costs, and cancer and HIV-related clinical outcomes. The rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach will both increase timely treatment adoption and be scalable and sustainable after the project is completed. This innovative study responds directly to the call by the National Cancer Institute to develop and test implementation strategies in cancer control in LMICs. Furthermore, the highly efficient design enables the comparison of different adaptive strategies within one study, helping to advance an understanding of the minimum level of intervention needed to improve and sustain cancer control in lower resource settings. If successful, these strategies can be ea...