CERVICAL CANCER “An NCD We Can Overcome” Therese LETHU Global Health Objectives Acronyms GHO ..........................................................Global Health Objectives CKC............................................................Cold Knife Conization EVA System ..............................................Enhanced Visual Assessment GFATM ......................................................Global Fund Against Aids, Tuberculosis and Malaria HPV ...........................................................Human Papillomavirus HUG ..........................................................Hospitals University of Geneva ICT..............................................................Information and Communication Technology ITU..............................................................International Telecom Union IAEA ..........................................................International Atomic Energy Agency IARC...........................................................Agency for Research on Cancer LEEP...........................................................Loop Electrosurgical Excision Procedure mHealth ....................................................Mobile Health MOH .........................................................Ministry of Health NCD ..........................................................Non Communicable Disease OIF ............................................................International Organization of the Francophonie Pap smear..................................................Papanicolaou test PEPFAR .....................................................The U.S. President's Emergency Plan for AIDS Relief SMS............................................................Short Message Service STI ..............................................................Sexual Transmitted Infection TB ..............................................................Tuberculosis UNICEF .....................................................United Nation’s Fund for Children UNAIDS ....................................................The Joint United Nations Program on HIV/AIDS UNFM .......................................................Université Numérique Francophone Mondiale UNFPA ......................................................United Nations Population Fund UNDP.........................................................United Nations Development Program USNCI .......................................................Us National Cancer Institute VIA..............................................................Visual Inspection with Acetic Acid VILI .............................................................Visual Inspection with Lugol's Iodine WHO..........................................................World Health Organization Cervical Cancer in Africa : “An NCD We Can Overcome” “This was the theme of the round table we organized in Geneva with various experts to highlight the way forward. This is the report of the discussion”. 22 May 2016 - 3.30 to 6.30 pm Starling Hotel, Geneva Geneva - July 2016 Therese LETHU Global Health Objectives 1 AGENDA Thérèse Lethu, Executive Director, Global Health Objectives: Welcoming words and moderator .........................................................................P. 3 Michel Sidibé, Executive Director, UNAIDS: HIV/HPV Interactions: new opportunities for joining forces ..................................P. 4 Prof John-Paul Bogers, Coordinator of The WAKA-HPV Project: A promising public and private approach at regional level ...................................P. 7 Dr Sharon Kapambwe, National Coordinator Cancer Prevention, Ministry of Health, Zambia: Lessons learned from experience ..........................................................................P. 9 Curtis Peterson, VP Global Health Mobile ODT: Screening cervical cancer using mobile phones ....................................................P.13 Dr Anne-Caroline Benski, Obstetrician/gynecologist, University Hospital of Geneva: Innovative Mobile Health System for HPV Screening in Low Income Countries ...P.14 Dr Ophira Ginsburg, WHO: The new UN Global Joint Program for Cervical Cancer Prevention and Control..P.16 Dr Qhing Qhing Dlamini: Afya Health Management Associates: The way forward .....................................................................................................P.17 Discussion: key insights ................................................................................................P.18 Therese Lethu: Conclusions ............................................................................................................P.24 2 Therese Lethu, Executive Director, Global Health Objectives (GHO): Welcoming words and overview According to WHO, screening and treatment of cytology (Pap test). Molecular-based HPV diagnos- pre-cancerous lesions to prevent cervical cancer is tics are being tested in research and pilot projects in one of the “best buy” for addressing NCDs preven- a number of countries to clarify the diagnostic, cli- tion and control, while reducing premature deaths nical, and programmatic implications of HPV scree- by 25% by 2025. Taking into account current and ning for cervical cancer prevention. In addition, two projected burden of disease, cost-effectiveness, certified HPV vaccines provide new powerful tools fairness, technical knowledge and feasibility of new to scale up current programs, with the potential to interventions, cervical cancer programs have pro- prevent 70% all cases. (Newer vaccines which tar- ven to be cost-effective and high-impact initiatives. get more of the cancer-causing subtypes of HPV will eventually be able to prevent a greater proportion Cervical cancer remains the most common type of cases, for example Gardisil 9, which targets 9 sub- of cancer among women in sub-Saharan Africa: af- types, currently prohibitively expensive for most fecting as high as 22%. In the WHO AFRO region, countries). every year, 34 out of every 100 000 women are dia- gnosed with the disease and 23 out of these die HIV/HPV co-infection is another opportunity to in- [REF Globocan/IARC]. Human papil- tegrate screening of cervical can- loma virus (HPV) is the primary cause cer into existing HIV testing and of cervical cancer. While most infec- counseling, care and treatment tions with HPV are cleared by the bo- services. According to scientific dy’s immune system, some infections sources, there is a higher inci- persist and lead to cervical dysplasia, dence, greater prevalence and pre-cancers and ultimately invasive longer persistence of HPV in- cancer Despite being one of the few fection amongst HIV infected types of cancer that can be prevented women. Research is ongoing with a vaccine and by screening with to develop more effective and simple treatment of pre-cancers, cost-effective methods of scree- more than 95% of affected women ning and treatment, but cryothe- have never been screened for the rapy, large loop excision of the disease. Cancer control programs are not yet part transformation zone (LEEP/LLETZ), and cold knife of existing primary sexual and reproductive health conization (CKC) are standard practices depending care services. Knowledge and awareness of this on the clinical situation and the setting*. disease remains poor, and facilities for prevention, diagnosis and treatment are still widely inadequate. Our roundtable highlighted new major strategic As a result, most of women are diagnosed at the and technologic steps for advancing screening and advanced stage and this incidence is on the increase treatment of cervical cancer in Africa, raising awar- in some countries. eness and providing key data to help political lea- However, new strategies to both primary and se- ders, partners and funders to take action. condary prevention have been scientifically proven Prior to the sixty-ninth World Health Assembly, held over the last decade. The approaches, tools and in Geneva, from 23 to 28 May 2016, the roundtable equipments for new screening methods, vaccina- enabled Commonwealth member countries’ dele- tion, treatment and awareness should create addi- gates to participate in the discussion. An interactive tional opportunities for innovative actions, syner- exchange provided an overview of current interven- gies and promising partnerships. tions and research as it relates to cervical cancer in Africa. Particular emphasis was placed on assessing Such interventions should help increase access for the enabling environment for those strategies to women aged 30–49 years to early treatment and succeed, exchanging experiences and knowledge screening to identify precancerous lesions, as re- for optimizing results, including standard data col- commended by WHO guidelines. Available scree- lection and analysis for quality control. ning tests include a Human Papillomavirus (HPV) *http://www.who.int/reproductivehealth/publications/can- test, Visual Inspection with Acetic Acid (VIA), and cers/cervical-cancer-guide/en/ 3 Michel Sidibé, Executive Director, UNAIDS: HIV/HPV Interactions: new opportunities for joining forces As Executive Director of UNAIDS, since 2009, technologies, programmes and entry points that Michel Sidibé’s vision of zero new HIV infections, are mobilized for HIV prevention, treatment, care zero discrimination and zero AIDS-related deaths and support can be successfully combined with has been integral in securing HIV as a priority of other sexual and reproductive health services, in- political agendas. Having spent more than 30 cluding those for cervical