Unitaid-funded program spurs more partners to join efforts to eliminate cervical cancer
In just under five years, Unitaid-funded and CHAI-supported cervical cancer programs across 10 low-and middle-income countries—where nearly nine out of 10 women die of the disease—have reached more than a million women with cervical cancer screening services.
It’s a long way from the days when women would arrive at a clinic for screening or treatment—sometimes traveling tens of miles by foot to get there—only to find the single doctor trained to do it was busy, says Claudine Chibawa.
Chibawa is the Cervical Cancer Coordinator at the Chinsali District Hospital in Muchinga Province, Zambia. She says the change since the program began has been dramatic.
“Before there were a lot of women with suspected cases of cervical cancer, but we could only see three cases per day,” she says. With women traveling up to 80 kilometres to reach the hospital, it could be quite difficult to reschedule and return for their appointment—making it more likely for their cases to progress from easily treatable pre-cancerous lesions to cervical cancer, which has far worse health outcomes.
Claudine Chibawa, Cervical Cancer Coordinator, Chinsali District Hospital, Muchinga Province, Zambia
Through Unitaid funding, CHAI supported the renovation of Chinsali District Hospital to create a dedicated cervical cancer unit and train more doctors to deliver cervical cancer services. CHAI also supported the Zambian Ministry of Health to introduce new technologies, including human papillomavirus (HPV) tests and thermal ablation devices, that allowed nurses and other health workers to begin screening and treating the condition.
We use this same approach partnering with governments in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, and Zimbabwe, in addition to Zambia, to strengthen cervical cancer prevention programs.
Our goal is to end the disease. This is in line with the bold vision for cervical cancer elimination by 2030 set by the World Health Organization (WHO).
The Shift to HPV Testing
Toward this goal and through Unitaid’s support, we have worked with health ministries since 2019 to deliver a package of affordable, effective tools such as HPV tests and thermal ablation devices, for screening and treating cervical pre-cancer. There is strong data supporting WHO’s recommendation for countries to move to HPV testing as a primary screening method given its high sensitivity in detecting pre-cancerous cells.
More countries are motivated to make the shift to HPV testing, especially as it provides women the opportunity to self-collect samples, reducing demand on healthcare workers while circumventing the need for a pelvic exam. HPV testing has been endorsed in the national screening guidelines of eight out of 10 program countries (Kenya, Malawi, Nigeria, Rwanda, Zambia, Senegal, Uganda, Zimbabwe).
Scaling the use of self-sampling of HPV tests has the potential to increase screening coverage, thus making it accessible to more women, especially when taken to community settings. However, important evidence gaps remain on the feasibility and impact of adopting these community-based self-sampling models and associated delivery models in low- and middle-income country contexts.
With more countries adopting and scaling up the use of these tools, the evidence gap will eventually get closed. As of April 2023, over 1.3 million women have been reached with screening services, including 400,000+ screened with highly sensitive HPV tests—with over 82 percent of eligible women completing treatment across partner countries. At project sites in four of those countries, Malawi, Nigeria, Rwanda, and Senegal, treatment targets exceeded 90 percent—seven years ahead of the schedule set by the WHO.
To achieve this milestone, CHAI supported the introduction of over 5,000 thermal ablation devices for treating pre-cancerous lesions in 24 countries across Africa, Asia, and Latin America, with nearly 50 percent of the deployed devices placed at primary health level thus decentralizing treatment access. To facilitate the uptake, Unitaid and CHAI secured pricing agreements that reduced the costs of the devices by nearly 45 percent.
These hand-held, battery powered devices replace heavy cryotherapy devices that require compressed gas. Thermal ablation also allows women to receive treatment closer to home.
“We were just screening women and referring them to bigger hospitals for treatment,” says Chibawa of the situation for women at Chinsali hospital. “CHAI brought in the thermal ablation devices and it became easy for the facilities to test and treat women on the same day then and there. Now there are no backlogs.”
Welcoming new partners
The success of the programs we have built together with government partners has spurred others to join the elimination initiative. In August 2023, CHAI announced its partnership with the Judith Neilson Foundation to help bring cervical cancer prevention and treatment services closer to more women in Zimbabwe where the disease is the leading cause of death among women living with HIV.
From Left to Right. Community health workers Ottilia Kamuriwo, Shiella Mawari, Euritah Masanga and Theresa Mukouyo at Chidamoyo Christian Hospital, Mashonaland West, Zimbabwe.
In Zimbabwe, women are often diagnosed too late due to long distances to facilities, high transportation costs, limited disease awareness, and access to screening and treatment services. CHAI, with funding from the Judith Neilson Foundation, is supporting the Ministry of Health and Child Care to decentralize screen and treat services, bringing them closer to rural and underserved communities.
“We hope our success so far will inspire more countries and partners to implement programs to help protect the health of women and provide access to crucial treatment,” says Joshua Chu, Executive Vice President, Vaccines and NCDs, at CHAI.
As part of their continued commitment to cervical cancer elimination, Unitaid has also extended support to CHAI for another two years with a sharper focus on tackling some of the immediate gaps in the cascade of cervical cancer care—particularly to increase the opportunity for women to self-screen. Six countries are interested in exploring the different models of community-based self-collection, work that will generate evidence to further inform future guidelines and best practices on the screening approach. CHAI will also continue to support partner governments to further optimize laboratory delivery of HPV testing, as well as community-based and grassroots advocacy for cervical cancer services.
The fight against cervical cancer has largely been a fight against inequalities, one we plan to continue so that future generations of women can live cervical cancer free lives.
