Cervical cancer is the second most common cancer in women worldwide, with 500,000 new cases and 250,000 deaths reported each year. Approximately 80% of cases occur in developing countries, where more than 95% of women have never had a Pap test. Many of these cases can be avoided through early screening and treatment, and now also through vaccination against human papillomavirus (HPV), the virus that can lead to cervical cancer.
Working with stakeholders and partners, Jhpiego pioneered the single visit approach (SVA), a unique, medically safe, acceptable and effective approach to cervical cancer prevention for low-resource settings. The SVA consists of visual inspection using vinegar or dilute acetic acid (VIA) to detect precancerous lesions on the cervix, followed by the offer for treatment using a freezing technique (cryotherapy), in the same visit.
Jhpiego’s Approach to Cervical Cancer Prevention and Treatment
Jhpiego first conducted early clinical trials of VIA in Zimbabwe in 1995. Subsequently, we implemented projects to assess the safety, acceptability, feasibility and effectiveness of the SVA and found that it is a cost-effective intervention that can be practically implemented in low-resource settings. Jhpiego has since provided technical assistance to establish and scale up cervical cancer prevention programs in Ghana, Guyana, Indonesia, Malawi, Philippines, South Africa and Thailand, and has participated in advocacy initiatives in Ethiopia, Kenya, Mozambique, Nepal, Peru and Tanzania.
Jhpiego implements a comprehensive approach to cervical cancer programming with the following key components:
- Policy and advocacy: raising awareness, galvanizing governments and funders to take action, and assisting in the development of policies and guidelines to support activities to prevent cervical cancer
- Human resource development: developing training resources and conducting competency-based training for health care providers and supervisors
- Service delivery: working with local stakeholders to build a sustainable service delivery system that addresses procurement, repair and maintenance of equipment; monitoring and evaluation; and supervision for consistent quality of services
- Referral systems: strengthening linkages within the health system to ensure that women receive the appropriate follow-up and treatment
- Outreach and education: developing culturally appropriate materials for community education and mobilization, and training community outreach workers to effectively promote screening
To date, cervical cancer prevention efforts have been focused on the general population. A specific focus on HIV-positive women represents a new frontier. Globally, an estimated 50% of adults infected with HIV are women, and these women have higher incidence, greater prevalence and longer persistence of HPV infection. Consequently, they also have a higher risk of developing precancerous lesions, and may have more rapid progression to cancer than women who are not HIV-infected. Building upon its vast experience in establishing and scaling up cervical cancer prevention programs, Jhpiego is currently working in the groundbreaking area of integration of these programs with existing HIV care and treatment services.