Before Time – Empowering Women and Communities for Protection Against Cervical Cancer is a programme co-funded by the Interreg VI-A IPA Croatia–Bosnia and Herzegovina–Montenegro programme. It started on 1 September 2024 and will run for 30 months, until 28 February 2027.
The project is coordinated by the Public Health Institute of Zadar and involves six partners from Croatia, Montenegro and Bosnia and Herzegovina: Public Health Institute of Zadar (Zadar, Croatia), Institute of Public Health of Montenegro (Podgorica, Montenegro), Mostar Health Centre (Mostar, Bosnia and Herzegovina), Tivat Health Centre (Tivat, Montenegro), Institute for Mediterranean Economic Perspectives (Split, Croatia), and Croatian Institute of Public Health (Zagreb, Croatia).

The project title “Before Time” carries the message that it is important to apply preventive measures before the disease develops, with the slogan: “Protect yourself today, think about tomorrow!”. The project raises awareness about the importance of prevention and early detection before cervical cancer becomes invasive, and contributes to achieving the goals of the World Health Organization (WHO) and the European Cancer Plan, which focus on eliminating and preventing cervical cancer and other HPV-related cancers.

The WHO has set a global target for the elimination of cervical cancer as an incidence rate of less than 4 per 100,000 women per year. In Croatia, around 300 new cases of cervical cancer are recorded annually, which corresponds to a rate of about 13 per 100,000 women.

1. Primary prevention will be aimed at teenagers, adolescents, young people up to the age of 25, and their parents, through education and campaigns about HPV vaccination and health promotion.

2. Secondary prevention will be aimed at women aged 20–64 through education on the importance of regular gynecological check-ups. In addition, women over the age of 30 will be invited to take part in a pilot HPV screening project to detect precancerous changes and early-stage cervical cancer, prevent the development of invasive cancer, and begin timely treatment, when treatment outcomes are more favorable.

Project activities include informing, educating, implementing campaigns, promoting HPV vaccination programmes and regular gynecological check-ups, and motivating and encouraging women and young people to participate in prevention programmes.

Primary prevention activities target parents, children and adolescents (aged 9–18), young people (up to 26 years old), and non-health professionals. Secondary prevention activities target women, especially those aged 20 to 64, as well as healthcare professionals.

Primary prevention in the Before Time project is focused on teenagers, adolescents, young people up to the age of 25, and their parents. It will be carried out through education, information campaigns, and awareness-raising activities about HPV vaccination and health promotion. The goal of primary prevention is to inform and educate young people and their parents about the risks of HPV infection, protection against transmission, the importance of timely vaccination, and the promotion of healthy lifestyle choices that reduce the risk of disease development.

Educational campaigns, workshops, and public health initiatives within the project will be implemented through social media, the online Educa platform, promotional materials, and video content.

Project partners involved in Before Time will develop a communication strategy consisting of promotional messages tailored to different target groups. As part of the campaign, a video will be produced featuring messages about the protection of sexual and reproductive health and the importance of vaccination against HPV infection.

Secondary prevention includes activities aimed at women aged 20 to 64, with the goal of early detection of changes in cervical cells, which, if unrecognized and untreated, can lead to cancer development. One of the key activities within the Before Time project is the pilot testing of HPV self-sampling. Through the pilot implementation of HPV self-sampling, women are given access to testing without the need to visit a medical office.

The Public Health Institute of Zadar County is responsible for the distribution and analysis of the test samples, while partners from other countries are in charge of local-level implementation. Special attention is given to removing barriers to enable as many women as possible to participate in screening programs.

To ensure the quality and sustainability of the project, educational workshops are organized for healthcare workers and local community experts. The goal is to empower them with knowledge, skills, and motivation to carry out the project’s activities.

The Croatian Institute of Public Health leads the development of educational materials and a targeted communication strategy, which will serve as a foundation for future local and national campaigns. The project also contributes to the strengthening of non-institutional services, supporting the development of a more resilient healthcare system and improving access to healthcare services.