Saving Women's Lives in Latin America and the Caribbean: Improving Cervical Cancer Screening and Treatment Quality and Access

Abstract

Background and context: It is the third leading cause of cancer deaths among females in Latin America and the Caribbean, and yet cervical cancer is almost entirely preventable and treatable. In a region where many lack even basic access to quality sexual and reproductive healthcare, screening and treatment services for HPV and cervical cancer are far from universally available. International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and its member associations (MAs) are working to reverse this trend, identifying and bridging local gaps in access and services wherever possible. Aim: IPPF/WHR and its MAs seek to improve both providers' ability to deliver - and women's ability to access - quality cervical cancer screening and treatment through institutional capacity building, the introduction of new technologies, advocacy and community awareness efforts. Strategy/Tactics: 1) Increase cervical cancer services by training providers in the provision of low cost, high capacity screening and treatment methods, including visual inspection with acetic acid (VIA), HC2 and HPV DNA screening technologies, and a single-visit approach (SVA) to treatment using cryotherapy, thermocoagulation and LEEP. 2) Educate populations and increase demand for cervical cancer services by implementing public awareness campaigns and community information, education and communication (IEC) activities promoting the importance of early detection and treatment. 3) Improve and standardize clinical protocols and referral pathways by advocating among and collaborating with key decision-makers and local ministries of health. Program/Policy process: MAs are implementing small-scale pilot studies to incorporate VIA, HC2 and HPV DNA screening and new treatment to provide even greater numbers of women with potentially life-saving diagnostics and care in Belize, Honduras, El Salvador and Bolivia. As leading clinical experts and advocates, several MAs are also working with public sector counterparts to refine two-way referral pathways, standardize screening protocols and clinical guidelines, and to ensure data quality and collection. A range of Caribbean MAs have also been trained in the use of VIA, cryo and LEEP. Outcomes: From 2016 to 2017, MAs from Belize, Grenada, Suriname, and several additional Caribbean countries who received training in VIA and other screening and treatment techniques saw an average 7% increase in the number of direct cervical cancer services provided. MAs from Belize, Bolivia and Honduras also contributed to updated national cervical cancer protocols. What was learned: An effective national response to cervical cancer requires the support and collaboration of civil society organizations, which can deliver direct services and play a catalytic role in advancing technical recommendations and policy dialogue. Countries should continue to improve the quality of VIA services, until more advanced screening technologies become available and can be scaled up.