Reducing Health Inequities in the Prevention of Cervical Cancer

In sub-Saharan Africa, cervical cancer continues to be the leading cause of cancer-related death among women. This overlaps with a high prevalence of HIV in the region. Women living with HIV are six times more likely to develop cervical cancer. As pre-cancerous lesions and cervical cancer can be cured if detected and diagnosed early and treated promptly, screening programmes remain fundamental to the prevention of cervical cancer. There is however a lack of comprehensive patient and data management systems, which hinders the systematic implementation, monitoring and evaluation of cervical cancer screening programmes for women living with HIV.

To tackle this issue, Swiss TPH together with partners developed the Cervical Cancer Prevention and Care Cascade. It is an innovative framework tailored to girls and women living with HIV in sub-Saharan Africa to monitor and scale up cervical screening services at HIV clinics in sub-Saharan Africa.

Prevention and treatment of cervical cancer in health facilities

To understand the state of cervical cancer prevention and care in contexts with a high HIV burden, researchers analysed the policy landscape and assessed the prevention and treatment of cervical cancer at health facilities in 14 countries in sub-Saharan Africa. Results showed that there often remains a considerable gap between the WHO target of 70% of women screened and 90% of women treated for cervical pre-cancer and actual screening and treatment rates.

Together with experts from 15 sub-Saharan African countries key indicators have been identified to collect the required data to manage cervical cancer control services. The availability of high-quality data and indicators is crucial to strengthen prevention efforts, ensure early detection and provide appropriate care. The indicators will facilitate standardised data collection and reporting and inform decision-making processes to improve or scale-up cervical cancer screening and care services.

Using machine learning for data analysis

Another challenge is the lack of interoperable data systems across health facility service areas. This presents a barrier to ascertaining the uptake of cervical cancer screening services among women living with HIV. In Zambia, researchers applied machine learning to combine the data sources for HIV care and cervical cancer prevention and care. The use of machine learning techniques offers an efficient solution with limited resource requirements.

Barriers and facilitators

In Zambia, a comprehensive analysis of the uptake of cervical cancer services was conducted in communities and health facilities. It identified both barriers and facilitators to cervical cancer screening and treatment services. Barriers included misinformation and concerns related to stigma and screening procedures or financial constraints. Facilitators included the perceived benefit of knowing one’s health status, encouragement from family and peers and transport reimbursement to get to the clinic. The findings highlighted the need to intensify community sensitisations. This was done using street drama and radio shows to increase knowledge and address fears and misinformation. 

Achieving the WHO strategy to eliminate cervical cancer

Finally, the framework could be considered for programme monitoring permitting for comparability across and within countries as we track progress towards the 2030 WHO targets on cervical cancer elimination. In addition, understanding the barriers and facilitators to cervical cancer service uptake in Zambia helps to address identified infrastructure, capacity building and community awareness issues to improve cervical cancer prevention and care, and ultimately contribute to the WHO strategy towards cervical cancer elimination.

About the project

The Cervical Cancer Prevention and Care Cascade was developed within the Advancing Cervical Cancer Screening in HIV-positive women (ACCHIVe) project. The project was led by Swiss TPH in a consortium with the Centre for Infectious Disease Research in Zambia (CIDRZ) and the Ministry of Health of Zambia. It was implemented between 2018 and 2023. Other partners included the International epidemiology Databases to Evaluate AIDS (IeDEA) regional research programmes in Southern Africa, Central Africa, East Africa and West Africa as well as the International Agency for Research on Cancer (IARC). The project was funded through the Swiss Programme for Research on Global Issues for Development (r4d programme), a joint programme of the Swiss National Science Foundation (SNSF) and the Swiss Agency for Development and Cooperation (SDC), and by the National Cancer Institute (NCI), USA.