Cervical cancer. Screening and treatment of pre-cancerous lesions for secondary prevention of cervical cancer

Five facts about cervical cancer and how Unitaid is battling the disease

Q&A

  • What is cervical cancer?

Cervical cancer is a common cancer in women, with about 570,000 new cases in 2018 and more than 311,000 deaths—85 percent of them in less-developed countries. Cervical cancer is caused by human papillomavirus (HPV), an extremely common sexually transmitted infection. While most HPV infections clear up on their own, and precancerous lesions resolve, some infections progress to invasive cancer.

  • What are the risk factors for cervical cancer?

Cervical cancer can develop in just 5-10 years in women with weakened immune systems, such as those living with HIV, compared to 15-20 years in women with normal immunity. Co-infection with other sexually transmitted infections like herpes simplex, chlamydia and gonorrhea also predisposes women to cervical cancer. Other risk factors include smoking, having many babies and bearing children at an early age.

  •  Why is Unitaid targeting cervical cancer?

Cervical cancer is one of the most preventable and curable cancers, if diagnosed early and managed effectively. The number of deaths due to this disease have increased by 17% since 2012. If we do not act, the death toll will rise by almost 50% by 2040. Women living in lower income countries are more than eight times more likely to develop cervical cancer than those in high-income countries. Women living with HIV are four times more likely to develop cervical cancer once infected with HPV.

Screening and treatment of precancerous lesions are the norm and have proved successful in high-income countries. However, high costs, ineffective screening methods and treatment devices that are hard to use in remote settings have held back progress.

Unitaid’s upcoming investments seek to reduce cervical cancer illness and death by expanding access to better tests and treatments that are affordable, effective and handy.

  • What will Unitaid’s first investment in cervical cancer focus on?

Unitaid’s first project in cervical cancer will be led by Clinton Health Access Initiative (CHAI). The US$ 33 million initiative will be implemented in India, Kenya, Malawi, Nigeria, Rwanda, South Africa and Zambia.

Aiming to develop US$ 1 screen-and-treat solution for cervical cancer, the project will pioneer a common cellphone application using artificial intelligence that can detect signs of cancer with more than 90% accuracy. The initiative will also expand access to affordable and portable treatment devices for precancerous lesions.

  • How does Unitaid plan to contribute to global targets for cervical cancer elimination?

Unitaid’s innovations are designed to be scaled up by partners such as the Global Fund and PEPFAR. If broadly adopted, the innovations could save the lives of hundreds of thousands of women, including those living with HIV, and empower them to lead healthy and productive lives.

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Unitaid and CHAI sign grant to prevent cervical cancer deaths

Geneva – Unitaid and Clinton Health Access Initiative (CHAI) today signed an innovative grant that will bring artificial intelligence and affordable treatment and screening to the fight against cervical cancer, a disease that kills a woman every two minutes and disproportionately affects low-resource countries and women living with HIV.

With the aim of achieving US$ 1 screen-and-treat solutions, the $33 million project will deploy improved screening tools, introduce new portable devices for treatment and advance easy-to-use artificial intelligence-based tools for screening of precancerous lesions. Precancerous lesions can progress to life-threatening cervical cancer if left untreated.

Starting in July, the 2.5-year project will be implemented in India, Kenya, Malawi, Nigeria, Rwanda, South Africa and Zambia.

“Early detection of cervical cancer is key to saving lives. The use of artificial intelligence in cervical cancer screening will be a game-changer, and we are proud to be pioneering it,” Unitaid Executive Director Lelio Marmora said. “Unitaid is delighted to join forces with CHAI in reducing the world’s cervical cancer death toll.”

Marmora and CHAI CEO Ira C. Magaziner signed the grant Sunday during the high-level discussion “How to halve HIV deaths”.

“By investing in innovative screening methods and portable treatment devices for cervical pre-cancers, CHAI’s collaboration with Unitaid will not only help overcome one of the most preventable and treatable cancers, but also empower hundreds of thousands of women to lead healthier lives,” Magaziner said.

Cervical cancer is the fourth most common cancer in women. It affects over half a million women each year and kills more than a quarter of a million. Virtually all cervical cancers are caused by infection with human papillomavirus (HPV), a very common sexually-transmitted infection.

Women in low- and middle-income countries are six times more likely to develop cervical cancer than women in high-income countries. Nine out of ten deaths occur outside of high-income countries.

Women living with HIV have four to ten times greater chance of developing cervical cancer when infected with HPV than HIV-negative women, making cervical cancer a major threat to the health of women living with HIV.

In high-income countries, several strategies have proved successful in decreasing the cervical cancer burden, including early detection and treatment of precancerous lesions. In remote settings, however, progress has been held back by high costs, ineffective screening methods and ill-adapted treatment devices. A fresh approach is needed in low- and middle-income countries.

By improving access to affordable, high-quality screening and treatment for cervical cancer, the grant paves way for widespread scale-up and builds on Unitaid’s growing investment in management of HIV co-infections. The new generation of tools complements other cervical cancer control approaches, such as HPV vaccination, contributing to the WHO’s targets for elimination of cervical cancer.

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End of project evaluation of the market entry grant to the diagnostics for the Real World on SAMBA

New study is a breakthrough for preventing tuberculosis in people living with HIV

Geneva – A Unitaid-funded study has found that 3HP, a new, shorter preventive therapy for tuberculosis, is safe for people who also take the HIV drug dolutegravir. The results mark a critical milestone for countries and funding partners seeking to expand preventive TB therapy.

“These are the results we have all been waiting for,” Unitaid Executive Director Lelio Marmora said. “The evidence that 3HP is safe to use with dolutegravir, today’s most advanced HIV treatment, is critical for the scale up of short-course preventive therapy for TB. We now need to focus on affordable pricing for access.”

TB kills some 340,000 people living with HIV every year and accounts for about a third of HIV-related deaths. TB preventive therapy protects people already infected with TB bacteria from falling ill with the active disease and shields those at risk of exposure. A third of the world’s population is infected with latent TB, and HIV infection makes them much more likely to develop active TB.

The new therapy, a rifapentine-based regimen known as 3HP, requires only once-weekly treatment for 12 weeks, compared to the 6-to-36 month daily regimen required under the older standard of care, isoniazid preventive therapy (IPT). Patients are more likely to complete shorter treatments.

The study was carried out in South Africa by Unitaid grantee Aurum Institute and the Johns Hopkins University Center for TB Research as part of the IMPAACT4TB project.

Unitaid is investing US$ 59 million in the Aurum-led IMPAACT4TB (2017-2021) project, which seeks to establish rifapentine-based preventative regimens as affordable, quality-assured, less-toxic therapies suitable for wide introduction in countries most affected by TB.

The study also found that people who take 3HP do not require a higher dose of dolutegravir, and that all viral loads were suppressed while the patients were taking 3HP.

The findings were presented today in Seattle at the Conference on Retroviruses and Opportunistic Infections (CROI).

“Latent TB infection is the reservoir from which active cases develop, which in turn fuels transmission of the disease,” said Aurum Institute Group CEO Gavin Churchyard. “Scaling up new, safer, shorter prevention therapies, such as 3HP, is key to ending the TB epidemic.”

Today’s results allow IMPAACT4TB  to move forward with activities to improve the affordability and feasibility of TB prevention using 3HP. This work is expected to pave the way for the scale-up of 3HP by key funders of TB prevention interventions, including the Global Fund, PEPFAR and Stop TB Partnership.

“The news that 3HP is safe for people being treated with DTG opens the door to healthy, productive lives for a vast number of people who would otherwise die of tuberculosis,” said Dr Tereza Kasaeva, Director of the Global Tuberculosis Programme at WHO. “With scale-up as recommended by WHO’s new guidelines on latent TB infection, 3HP has enormous potential as a tool to help achieve the target of reaching 30 million people with TB preventive treatment by 2022, as outlined in the political declaration of the first UN High Level Meeting on TB in September 2018.”

The project is being implemented in the following countries: Brazil, Ghana, Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique, South Africa, India, Cambodia and Indonesia.

IMPAACT4TB stands for the full project name: Increasing Market and Public health outcomes through scaling up Affordable Access models of short Course preventive therapy for TB.

Unitaid seeks innovative, long-lasting technologies to help tackle diseases

Geneva – Unitaid is pleased to announce a call for proposals for projects speeding development of long-acting versions of medicines that could potentially revolutionize treatment and prevention of diseases including HIV, tuberculosis and malaria in low- and middle-income countries.

Safe and effective daily oral medicines are available for the prevention and treatment of major diseases, but they are not always taken consistently, resulting in worse health outcomes, the spread of illness and the development of drug-resistant superbugs.

Long-acting treatments include slow-release injectables, implants, patches or rings that can last more than a month, and oral medicines that can last more than a week. Delivering medicines this way frees patients from complex, daily regimens with many pills, and could also improve access and address stigma.

Unitaid is soliciting proposals that:

• Reformulate critical standard-of-care medicines into long-acting products.

• Enable sound plans to commercialize these products, including a scale-up strategy to introduce them on a large scale.

• Focus on products that can be introduced in the market within three to five years.

Through calls for proposals, Unitaid finds smart new ideas to help alleviate the burden of diseases, and conducts pilots that, if successful, are scaled up by partner organizations such as the Global Fund. An independent review committee of global health experts helps Unitaid choose the best proposals to fund through a competitive selection process.

Unitaid joins Elton John AIDS Foundation and CIFF to drive HIV self-testing in Kenya

London –  Unitaid has joined the Elton John AIDS Foundation (EJAF), the Children’s Investment Fund Foundation (CIFF) and local partners to fund a campaign to persuade young people in Kenya to screen for HIV and get treatment if they test positive.

Mounting evidence shows that men, especially those in their twenties and thirties, are not accessing HIV testing and treatment in nearly high enough numbers, putting their own health at risk and fueling the spread of the virus among adolescent girls and young women.

Unitaid will contribute $1.5 million to a Challenge Fund co-financed with EJAF and CIFF that will invest $6 million over the next three years in innovative ways to get young men to access HIV self-tests. The project will be implemented by Population Services International (PSI).

Kenya is set to become the third largest HIV self-testing market in sub-Saharan Africa by 2020 and was also one of the first countries to adopt a national policy embracing the approach.

The agreement was signed at the AIDSfree Cities Global Forum, held at the House of Lords in London, by Unitaid’s Executive Director, Lelio Marmora, and EJAF’s Executive Director, Anne Aslett. UK International Development Secretary Penny Mordaunt welcomed the agreement in a speech at the forum.

“One in four people living with HIV do not know they have the virus, but evidence now shows that self-testing can contribute to changing this reality,” said Lelio Marmora. The Challenge Fund combines Unitaid’s expertise in creating markets for innovative health products with the know-how EJAF and CIFF bring in communications, branding and marketing.

Unitaid’s pioneering investments in HIV self-testing in Southern Africa – the Self-Testing Africa (STAR) Initiative – have produced strong evidence that self-testing is a highly effective and accessible way for young people to find out their status. Self-testing is now being introduced in West Africa.

“Young men have the potential to be a big part of the HIV solution and to play a role in the global mission to get to zero HIV transmissions,” said Anne Aslett.  “Through this collaboration, we are giving them the means and the tools to change infection rates in Kenya.”

The initiative springs from the MenStar Coalition and will tap into the best available marketing strategies to reach many more people at risk and persuade them to screen for HIV using self-testing kits.

Persuading young Kenyan men to use HIV self-testing kits is important to boost demand and sustain affordable prices in the region and beyond.  The Challenge Fund will develop and implement creative marketing strategies that can be adapted and replicated in other countries, creating a ripple effect.

The ATLAS project in West Africa: a big innovation at local level to achieve the global HIV screening goal by 2020

Dakar – HIV self-testing will be more widely disseminated and promoted in Côte d’Ivoire, Mali and Senegal so that people with the highest risk of contracting HIV can know their serological status in full confidentiality and contact treatment and prevention services.

The ATLAS project, which involves HIV self-testing and free access to information about one’s health status, is funded by Unitaid in the amount of more than US$ 15 million and is being rolled out by the Therapeutic Solidarity and Health Initiatives (Solthis) consortium and the Institute for Research and Development (IRD) in partnership with the health ministries of the three countries being targeted.

The project was officially launched today in Dakar, Senegal, in the presence of Colonel Boubacar Gueye, chief technical adviser to the minister of health, and Professor Sheik Tidiane Ndour, chief of the AIDS and STI control division, both representing H.E. the Minister of Health and Social Welfare, Unitaid Deputy Executive Director Dr. Philippe Duneton and Solthis General Director Louis Pizarro.

The ATLAS project, which will run for 3 and a half years, involves the distribution of 500,000 HIV self-testing kits in Côte d’Ivoire, Mali and Senegal, in addition to preparatory work to scale up a screening strategy by the governments involved and other partners, with the assistance of institutional, voluntary and research partners.

“For Unitaid, ATLAS is part of a more globalized investment strategy to promote HIV self-testing and screening in Africa, including in West and Central Africa, as a way to achieve high rates of HIV screening and thus help to reverse the epidemic trend”, explained Unitaid Executive Director Lelio Marmora.

Knowing HIV serological status is essential to stop the epidemic

In West and Central Africa barely half (48%) of people living with HIV know their HIV status.[1] Stigma and discrimination against people living with HIV are big obstacles to achieving the global screening goal.[2] Innovation is therefore essential to diversify screening options and reverse the course of the epidemic.

Even though infection rates are still moderate in West and Central Africa, including in the three countries where the ATLAS project is being rolled out, the HIV epidemic is concentrated within certain segments of the population, such as sex workers or men who have sex with men.  Through the use of self-testing kits, ATLAS will provide an additional screening option to reach populations at high risk of contracting the virus who fall outside the scope of existing screening services.

ATLAS project at the crossroads of technological innovation and societal trends 

By targeting populations at risk, ATLAS gives people who have never been tested before, or whose lifestyle warrants frequent testing, the opportunity and a tool to know their status and approach appropriate prevention and care services. The self-test, which is an oral device to detect HIV antibodies consisting of a spatula to be inserted into a reagent after rubbing across the gums, permits simple, rapid and confidential screening and empowers people to take ownership of their health.

The project will pave the way for the scaled-up introduction and deployment of the HIV self-test and stimulate the required demand for self-testing kits among these target populations.

The ATLAS Project also has a scientific aspect, bringing together IRD, which is piloting the research and evaluation component, the PAC-CI programme, the London School of Hygiene and Tropical Medicine and Imperial College (London).  Five studies will be undertaken to document the impact of HIV auto-testing as an essential complementary screening strategy and to identify which distribution models are most cost effective.  The findings will be shared with countries in the region to facilitate the adoption of the self-screening test and scale up its deployment.

Since 2015, Unitaid has played a pioneering role in promoting the HIV self-screening test with the Unitaid/PSI HIV Self-Testing Africa (STAR) Initiative launched by the NGO Population Services International (PSI) and its partners in six southern African countries.  To date, nearly 30 countries have incorporated the HIV self-test into their screening programmes.

Unitaid funding has bolstered MTV Shuga’s project to promote self-testing. In Côte d’Ivoire, the project will be rolled out by MTV Staying Alive Foundation in conjunction with ATLAS.  Its aim is to inform young people about self-testing via a television series.

[1] UNAIDS, 2017

[2] UNAIDS 90-90-90 objectives to be achieved by 2020 : 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, 90% of all people receiving antiretroviral therapy will have viral suppression.