On World Cancer Day, 4 February, Unitaid remains committed to ensuring women in low- and middle-income countries have access to life-saving preventive care for cervical cancer.
Though cancer does not discriminate, inequities caused by income, education, gender, and ethnicity, among many others, skew the burden of disease.
Cervical cancer is a particularly salient example. Despite being highly preventable and curable, it remains one of the most common cancers and a leading cause of cancer-related death worldwide.
In low- and middle-income countries where screening and treatment services are often unavailable, rates of cervical cancer are double those of high-income nations. More troubling still, nine out of ten cervical cancer deaths occur in these resource-limited settings.
But solutions exist. Unitaid is working with its partners to advance a package of cervical cancer prevention tools that are adapted to the needs of health settings in low- and middle-income countries. By integrating more effective, simpler, and more affordable methods for identifying women at risk of cervical cancer and providing timely pre-cancer treatment, Unitaid has developed a model for prevention that is already delivering enormous strides towards global cervical cancer elimination targets set by the World Health Organization (WHO).
Josephine is one of more than one million women who is already accessing services through direct Unitaid support. She tested positive for the human papilloma virus (HPV), the most common cause of cervical cancer, at a health center near her home in Rwanda. HPV is an extremely common virus amongst all sexually active women. It often resolves spontaneously but can cause complications when a persistent infection goes untreated.
New HPV tests like the one Josephine received replace a far less accurate, more labor intensive and subjective screening method based on visual inspection of the cervix. These tests, available at 40% of their original price thanks to agreements secured by Unitaid with the Clinton Health Access Initiative (CHAI), quickly and effectively identify women who are at risk.
Self-sampling kits go a step further to facilitate access. Allowing women to collect their own sample reduces demand on healthcare workers while circumventing the need for a pelvic exam which can act as a deterrent to care.
“I preferred to do the test myself,” says Josephine. “I’m not afraid of my own body, but it is a private process.”
“We’ve seen that self-sampling helps a lot of women feel more at-ease with the testing,” says Antoinette Mukamwiza, a nurse at the health center where Josephine was treated.”
“It also allows us to provide services to far more women. Now, two or three women can test themselves at the same time while I do the registry work. It helps us receive a lot more patients in the same amount of time.”
When a woman tests positive for HPV, a follow up is needed to identify and treat any abnormal cells on the cervix. Without treatment, these cells can develop into cervical cancer.
With portable, handheld, battery powered thermal ablation devices, pre-cancerous cells can be treated quickly in primary health centers. This provides an alternative to cryotherapy, which requires heavy equipment and compressed gas, meaning preventive services were limited to fewer centralized locations, when they were available at all.
The devices are more affordable, thanks to joint Unitaid-CHAI efforts that reduced the cost of this product by nearly 45%. However, field data from countries shows that the overall cost of thermal ablation is nearly ten times less than cryotherapy per woman treated.
Additionally, treatment with thermal ablation is significantly quicker – lasting only a couple of minutes compared to up to 15 with cryotherapy.
“When I learned that the doctor needed to remove some bad cells on my cervix, I definitely felt scared,” shared Josephine. “But my thoughts and fears far outweighed the process itself. It’s a very simple procedure, not something to worry about.”
“It’s inspiring to see how quickly Unitaid’s cervical cancer investments are producing results,” said Marisol Touraine, Unitaid Executive Board Chair, during a recent trip to Rwanda.
With more than US$70 million invested, Unitaid is one of the largest funders of innovative tools and strategies to find and treat cervical pre-cancer in women living in resource-limited settings. Unitaid-backed programs in 14 countries across three continents are developing and implementing models for cervical cancer screening and pre-cancer treatment in support of the WHO cervical cancer elimination strategy.
Programs in Burkina Faso, Côte d’Ivoire, Malawi, Nigeria, the Philippines, Rwanda, and Senegal are already using these tools to demonstrate strategies that are successfully treating 90% of all women identified to be at risk of cervical cancer, thus exceeding an important WHO target.
“We all have a role to play to ensure no woman suffers the injustice of a cancer that we know how to prevent due to an inexcusable lack in access,” said Touraine. “We share this success with our government and implementing partners, but we need to see urgent action to make these tools widely available everywhere they are needed.”
This World Cancer Day calls for action to close the care gap. Implemented widely, this package of tools for screening and preventive treatment can connect millions of women with critical care and contribute to achieving the WHO goal to eliminate cervical cancer.
Unitaid’s cervical cancer programmes are currently implemented in partnership with the CHAI and the SUCCESS consortium (Expertise France, Jhpiego, and the Union for International Cancer Control).
Photos credit: Aniket Ukey/Unitaid/CHAI
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