My talk at the World Cancer Congress was about the results from the Delphi consensus process that we conducted among more than 60 stakeholders from 15 countries in Sub-Saharan Africa with the aim to develop standardised indicators for monitoring and evaluation of cervical cancer screening programmes for women living with HIV.
What is the current situation of cervical cancer prevention in Sub-Saharan Africa?
As you know, in 2020 WHO published the global strategy to accelerate the elimination of cervical cancer as a global public health problem. In this strategy they highlighted the importance of cost-effective interventions for cancer control. These are HPV vaccination for girls, screening of women with high performance tests and appropriate and timely treatment for women who have been diagnosed with cervical disease. A year later, the regional committee of WHO for Africa developed a framework for implementation of this strategy with the aim to support these efforts and implement these interventions in their region.
What are the indicators for women living with HIV in Sub-Saharan Africa?
In our study we developed and agreed on 17 indicators that can be used to improve monitoring for cervical cancer prevention and care activities that reflect different domains of the continuum of care from prevention to screening, diagnosis and follow-up. Our indicators focus specifically on women living with HIV and for programmes that have been integrated into HIV and AIDS clinics across Sub-Saharan Africa but they can be adjusted and used in different settings as well.
What are some of the challenges in cervical cancer prevention and care in Sub-Saharan Africa?
There are several challenges that should be addressed to eliminate cervical cancer as a public health problem in Africa. Firstly, the low access of preventative services, including HPV vaccination, is an urgent problem that must be addressed soon. We also know that there is limited availability of screening programmes, specifically in rural areas. In addition, in the African region they still use low-performance tests such as VIA, or visual inspection with acetic acid, or Pap smear instead of high-performance tests as HPV testing is.
There are also high costs of treatment of pre-cancerous lesions, for example. The majority of countries in Africa they are using cryotherapy for treatment that requires gas and containers for gas and sometimes this brings additional costs for facilities that should be addressed. A huge problem, not only in Africa but everywhere in the world, is the lack of a healthcare workforce and specifically a skilled workforce for cancer control and prevention. Also the lack of infrastructure for tertiary prevention – what that means is that a woman, when she is diagnosed with cervical disease she should be referred for further treatment and care.
Lastly, what is the topic of my research is weak systems for monitoring and evaluation. We definitely need timely and reliable data to use it and inform programmes and policies in this region.
What were the results of the study?
In our study we asked stakeholders to rate several times indicators on a specific set of criteria. At the end we agreed on 17 indicators that reached consensus. Of these, five indicators reached consensus in all criteria they rated therefore we will recommend these indicators to be implemented in the current cervical cancer programmes that are integrated in HIV and AIDS clinics.
Anything else you’d like to add?
I would like to thank our collaborators in African countries and our funders. My research has been supported by the Swiss National Foundation and done in collaboration with the International Epidemiology Database to evaluate its idea.
