Screen, Notify, See, and Treat: Initial Results of Cervical Cancer Screening and Treatment in Rwanda

Abstract

PURPOSE To describe the first year results of Rwanda's Screen, Notify, See, and Treat cervical cancer screening program, including challenges encountered and revisions made to improve service delivery. METHODS Through public radio broadcasts, meetings of local leaders, church networks, and local women's groups, public awareness of cervical cancer screening opportunities was increased and community health workers were enlisted to recruit and inform eligible women of the locations and dates on which services would be available. Screening was performed using human papillomavirus (HPV) DNA testing technology, followed by visual inspection with acetic acid (VIA), and cryotherapy, biopsy, and surgical treatment for those who tested HPV-positive. These services were provided by five district hospitals and 15 health centers to HIV-negative women of age 35-45 and HIV-positive women of age 30-50. Service utilization data were collected from the program's initiation in September 2013 to October 2014. RESULTS Of 7,520 cervical samples tested, 874 (11.6%) screened HPV-positive, leading 780 (89%) patients to undergo VIA. Cervical lesions were found in 204 patients (26.2%) during VIA; of these, 151 were treated with cryoablation and 15 were referred for biopsies. Eight patients underwent complete hysterectomy to treat advanced cervical cancer. Challenges to service delivery included recruitment of eligible patients, patient loss to follow-up, maintaining HIV status confidentiality, and efficient use of consumable resources. CONCLUSION Providing cervical cancer screening services through public health facilities is a feasible and valuable component of comprehensive women's health care in resource-limited settings. Special caution is warranted in ensuring proper adherence to follow-up and maintaining patient confidentiality.

Socioeconomic inequalities in cervical pre-cancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe – Analysis of Population-Based HIV Impact Assessment surveys

“…The sample size of females aged 25-49 years ranged from 5882 in Ethiopia to 9186 in Tanzania. The median age and interquartile ranges were 32 years (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) in Ethiopia, 33 years (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) in Zambia and 34 years (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) in Malawi, Rwanda, and Tanzania. The rate of self-reported cervical pre-cancer screening was lowest in Rwanda (3.5% [95% CI 3.1%-4.0%]) and highest in Zambia (17.1% [95% CI 15.8%-18.5%]) and Zimbabwe (17.4% [95% CI 16.1%-18.8%]).…”

“…Governments could build cervical pre-cancer screening around a target population, such as eligible schoolgirls and colleague students, which would assist in addressing socioeconomic inequalities. For example, Rwanda vaccinated more than 90% of schoolgirls against HPV from 2011 to 2012, through designated "health days" which were adapted for other sexual reproductive and maternal health purposes [37,38]. This approach reduced time, money, and other costs of accessing HPV vaccination for girls, and other maternal health services for women [37].…”

Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda

“…[20] Cervical cancer screening helps its early detection and early treatment for those diagnosed with cervical cancer which results in favorable outcomes and survival. [5,21] When pre-cancerous lesions are detected, they can be treated with available cost-effective technologies such as cryotherapy or Loop Electrosurgical Excision Procedure (LEEP) which can decrease cervical cancer occurrence and its-related mortality in LMIC. [22] Rwanda has integrated non-communicable diseases prevention and control programs in primary health care services in the purpose to improve NCD care including screening and treatment services.…”

“…[4] An estimated 311,000 women died from cervical cancer worldwide in 2018, and 85% of these deaths occurred in low-and-middle income countries (LMIC) with Sub-Sahara Africa being the most affected. [4,5] High cancer-related mortality rate in LMIC is attributed to the inadequate access to effective screening services which results in low awareness of the diseases during its early stages and late diagnosis at the advanced stages with poor treatment outcomes. [6][7][8][9] Cervical cancer is preventable and curable if detected early enough and treated with available cost-effective technologies.…”

Changes in the Proteome in the Development of Chronic Human Papillomavirus Infection—A Prospective Study in HIV Positive and HIV Negative Rwandan Women

“…Cytology as a screening method is difficult to implement in developing countries due to a limitation in the number of cytologists. We and other research groups have shown that HPV screening may be used to identify women with high-grade cervical lesions in Rwanda [ 5 , 6 ]. While different approaches may be undertaken to reduce the number of cervical cancer cases, there is a risk of over-treatment, and the follow-up of patients at risk of cervical cancer is difficult to organize in many sub-Saharan countries.…”