An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan Africa

Abstract

OBJECTIVE Approximately 85% of cervical cancer cases and deaths occur in resource-constrained countries where best practices for prevention, particularly for HIV-infected women, still need to be developed. The objective of this study was to assess cervical cancer prevention capacity in select HIV clinics located in resource-constrained countries. METHODS A cross-sectional survey of sub-Saharan African sites of four NIH-funded HIV/AIDS networks was conducted. Sites were surveyed on the availability of cervical cancer screening and treatment among HIV-infected and HIV-uninfected women. Descriptive statistics, and chi-square or Fisher’s exact test were used as appropriate. RESULTS Fifty-one out of 78 (65%) sites responded. Access to cervical cancer screening was reported by 49 (96%) sites. Of these sites, 39 (80%) performed screening on-site. Central African sites were less likely to have screening on-site (P= 0.02) versus other areas. Visual inspection with acetic acid (VIA) and Pap testing were the most commonly available on-site screening methods at 31 (79%) and 26 (67%) sites, respectively. High-risk HPV testing was available at 29% of sites with VIA and 50% of sites with Pap testing. Cryotherapy and radical hysterectomy were the most commonly available on-site treatment methods for premalignant and malignant lesions at 29 (74%) and 18 (46%) sites, respectively. CONCLUSION Despite limited resources, the majority of sites surveyed had the capacity to perform cervical cancer screening and treatment. The existing infrastructure of HIV clinical and research sites may provide the ideal framework for scale up of cervical cancer prevention in resource-constrained countries with a high burden of cervical dysplasia.

To expand coverage, or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low-resource settings

“…The feasibility of expanding coverage to remote areas might be improved if screening can be integrated into existing HIV clinics that serve women with and without HIV infection. A recent survey of HIV networks in sub‐Saharan Africa indicated that on‐site access to cervical cancer screening with HPV testing was available at 18% of surveyed facilities, with cryotherapy available at 57% of sites . None of the HIV facilities that offer HPV testing in the survey were in Uganda, although some Ugandan clinics offer VIA and cryotherapy .…”

“…A recent survey of HIV networks in sub‐Saharan Africa indicated that on‐site access to cervical cancer screening with HPV testing was available at 18% of surveyed facilities, with cryotherapy available at 57% of sites . None of the HIV facilities that offer HPV testing in the survey were in Uganda, although some Ugandan clinics offer VIA and cryotherapy . Integration of HIV and cervical cancer screening programs has been identified as potentially beneficial by stakeholders in Uganda, if health worker shortages can be addressed .…”

Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening

“…However, use of dual Pap and VIA also has unique resource requirements and limitations, not too dissimilar to HR-HPV testing (e.g. specialized training and re-training for optimal performance, potential loss to follow-up awaiting the Pap result, and so on)[21]. Our results indicate that VIA alone, despite the benefit of a single visit approach in a population with high loss to follow-up, is not adequate for post-treatment screening since it would have missed nearly three-quarters of CIN2+ cases.…”

Female genital schistosomiasis (FGS) in Ogun State, Nigeria: a pilot survey on genital symptoms and clinical findings

“…The latter would only be possible if the eggs are viable, whereas calcified eggs would not excrete DNA. With promotion of the Sustainable Development Goals, there will be greater attention placed on women's well-being, which in part will focus upon reducing cervical cancers and increased screening for human papilloma virus (HPV) (Coleman et al 2016). It is evident that where urinary schistosomiasis is coendemic the health system should integrate detection of FGS within such wider surveillance.…”