Implementation of ‘see-and-treat’ cervical cancer prevention services linked to HIV care in Zambia

Abstract

Greater than 80% of the world's new cases and deaths due to cervical cancer occur in the developing world [1]. No more than 5% of women in these settings are screened for cervical cancer even once in their lifetimes [2]. Earlier attempts to establish population-based cervical cancer prevention programs using cytology screening in resource-limited settings have inevitably fallen short or failed [3][4][5]. Although many of the reasons for failure can be attributed to lack of resources and trained manpower, the multiple visit requirements of cytology-based screening programs jeopardizes success and sustainability.HIV infection is associated with higher incidence, more rapid progression, and increased recurrence rates of human papillomavirus (HPV)-associated cervical intraepithelial neoplasia (CIN) and invasive cervical cancer, an AIDS-defining disease [6][7][8][9][10][11][12][13][14]. The last decade has seen a global push for increasing access to affordable antiretroviral therapy (ART) for HIV-infected individuals in the developing world. Programs such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, have substantially upgraded healthcare infrastructures in many parts of sub-Saharan Africa and elsewhere at a scale never experienced in history [15,16]. Zambia has one of the world's highest cervical cancer incidence rates (53.7/100 000 women/year) and also a national adult HIV seroprevalence rate of 16% (23% in Lusaka, the capital city) [1,17]. Through PEPFARsupported programs, greater than 100 000 people (50% women) are now (September 2008) accessing ART in Zambia [18]. This care is largely delivered through partnerships between the public sector, nonprofit organizations, development agencies, and academic institutions. [19,20]. To our knowledge, this is the first effort within PEPFAR-supported programs to undertake cervical cancer prevention as a component of HIV care. We describe some of the major lessons learned through our experiences in the field operationalization of this program:1. Integration of the program within preexisting healthcare infrastructures ensures access to the target population and sustainability.Government-operated clinics provide healthcare for a majority of Lusaka's residents who cannot afford private sector care. We integrated cervical cancer prevention services into these public sector health clinics as a routine healthcare service for women. Significant advantages of integration include access to physical space, preexisting utilities, maintenance and toxic waste disposal services, and other medical/pharmacy services for patients and ease of referral to and from other departments within the health center. Improvements to the infrastructure from our program's funds benefited the general healthcare infrastructure, and vice-versa. Such circumstances facilitated the initiation and roll-out of our program, and soon changed the 'on the ground' view of our activities from 'special project' to 'routine service.'2. Piggy...

Influencing Women's Actions on Cervical Cancer Screening and Treatment in Karawang District, Indonesia

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An Evaluation of Novel, Lower-Cost Molecular Screening Tests for Human Papillomavirus in Rural China

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Bolivian Health Providers' Attitudes Toward Alternative Technologies for Cervical Cancer Prevention: A Focus on Visual Inspection with Acetic Acid and Cryotherapy

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