Cervical Cancer in Botswana: Current State and Future Steps for Screening and Treatment Programs

Abstract

Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.

Impact of Human Immunodeficiency Virus Infection on Survival and Acute Toxicities From Chemoradiation Therapy for Cervical Cancer Patients in a Limited-Resource Setting

“…However, radiation therapy is not currently available in the public sector. Therefore, patients are referred to a private hospital for CRT, which is fully funded by the government (6, 11). …”

“…In response, Botswana developed the first public HIV treatment program in Africa, with coverage now exceeding that of even the best-performing high-income countries (9). However, despite expanding access to antiretroviral therapy (ART), cervical cancer incidence has not declined (10, 11). As a result, public health interventions, such as a national cervical cancer screening program and an HPV vaccination program, are being implemented in Botswana to reduce the burden of locally advanced cervical cancer in the future (11, 12).…”

“…However, despite expanding access to antiretroviral therapy (ART), cervical cancer incidence has not declined (10, 11). As a result, public health interventions, such as a national cervical cancer screening program and an HPV vaccination program, are being implemented in Botswana to reduce the burden of locally advanced cervical cancer in the future (11, 12). However, it will take several years to observe the benefits of such interventions.…”

Predictors of Locally Advanced Disease at Presentation and Clinical Outcomes Among Cervical Cancer Patients Admitted at a Tertiary Hospital in Botswana

“…Approximately 200 cervical cancer patients are offered chemoradiation per year. 6 Cancer treatment is covered by the government, and 95% of the cervical cancer patients lodge at the PMH gynecology ward during their course of treatment where they also receive any necessary additional supportive care. Upon completion of therapy, discharged patients are followed up at the PMH multidisciplinary oncology clinic.…”

“…5 Although cervical cancer is a recognized health system challenge, the stage of disease at presentation, associated factors, and clinical outcomes have not been well documented. 6 This study describes the clinical stage at presentation, clinical and sociodemographic factors associated with stage of disease at presentation, and the short-term clinical outcomes among new cervical cancer patients admitted at the Princess Marina Hospital (PMH), a tertiary center in the country's capital.…”