One million women screened for cervical cancer in low-and middle-income countries
Geneva, 7 March 2023 – Over one million women in 14 low-and middle-income countries have been screened for cervical cancer through an integrated prevention program, delivered by country governments in collaboration with global health agency Unitaid, the Clinton Health Access Initiative (CHAI), and Expertise France as the lead of the SUCCESS project, in partnership with Jhpiego and the Union for International Cancer Control (UICC). Over 80 percent of women who have screened positive for cervical pre-cancer have received treatment.
This is part of a broader effort to develop scalable models for cervical cancer prevention that is adapted to lower income settings across Africa, Asia, and Latin America where nine in ten deaths from cervical cancer occur.
The program has seen countries train thousands of health workers and significantly expand the number of medical facilities offering life-saving screening and preventive treatment.
The program is designed around a package of high performing and cost-effective screening, preventive treatment, and planning tools and delivery methods, including:
- World Health Organization (WHO) tools to produce national costing plans for a prevention program using human papillomavirus (HPV) testing, which identifies the leading cause of cervical cancer and replaces a less accurate screening method based on visual inspection of the cervix.
- Introducing self-sampling methods for HPV testing, which circumvent the need for pelvic examinations–a promising technique to increase participation in screening programs.
- Supporting integrated patient monitoring tools, connected to national databases, across many program countries.
- Introducing portable thermal ablation devices, which provide a simpler and more affordable method of treating pre-cancerous cells on the cervix compared to traditional cryotherapy machines.
- Engaging and supporting civil society organizations to raise awareness within their communities of the services available, and in advocacy—essential for sustainable and long-term progress.
Additionally, the program is supporting development of artificial intelligence-based assessment tools–an emerging innovation with the potential to improve accuracy of visual screening methods.
Since October 2019, programs in Burkina Faso, Côte d’Ivoire, Guatemala, India, Kenya, Malawi, Nigeria, the Philippines, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe have been developing and demonstrating successful implementation of this package of care. With the program’s support, more than 250,000 women have been screened in Kenya, more than 190,000 women have been screened in India, and more than 200,000 women have been screened in Nigeria over the past three years.
By November 2022, program sites in half of these countries were achieving the World Health Organization’s (WHO) target to ensure 90 percent of women who screen positive for pre-cancerous lesions receive preventive treatment—seven years ahead of schedule, thus demonstrating effective models at scale that are ready to be replicated in other countries and contexts.
According to WHO, approximately 600,000 new cases of cervical cancer are recorded each year, resulting in over 340,000 deaths. However, cervical cancer is highly preventable when women have access to early screening and preventive treatment. The risk of cancer is reduced, and health outcomes improved the earlier infection is diagnosed.
Philippe Duneton, Executive Director of Unitaid comments: “With one million women reached so far, Unitaid is pleased to see that this package of effective and affordable technologies and delivery models is proving successful in fighting cervical cancer in low- and middle-income countries. We now call on governments and partners to urgently scale up these models of care and reduce the burden of cervical cancer in LMICs, where nearly all deaths from the disease occur.”
As part of the program, Unitaid and CHAI negotiated substantial price reductions for HPV tests of approximately 40 percent to less than US$9 and achieved an approximate 45 percent reduction in the cost of thermal ablation devices.
Joshua Chu, Executive Vice President, Vaccines and Non-Communicable Diseases, Clinton Health Access Initiative adds: “Reaching one million women screened for cervical cancer through the Unitaid-funded program is a major milestone, and we recognise the efforts of the Ministries of Health to prioritise resources to ensure women have an equal chance to live healthy and fulfilled lives. However, more needs to be done to rapidly expand these services, avert 65 million more deaths from this preventable and treatable disease over the next century, and ultimately eliminate cervical cancer as a public health threat.”
Through its various outreach and education strategies, the SUCCESS project has been able to achieve a high level of acceptability of self-sampling in its four implementing countries. Indeed, nearly 88 percent of women screened used self-sampling.
Eric Fleutelot, Technical Director, Major Pandemics Unit, Health Department, Expertise France mentions: “The devotion of the Ministries of Health with whom we collaborate, through cancer control programs, as well as HIV programs, demonstrates the interest of the implementation of these innovative solutions. For our efforts to be sustainable, and thus be able to reach several million women, we need to bring in more financial partners to this fight. The SUCCESS project has been pursuing various avenues to secure and expand funding streams, such as through other partners like L’Initiative and the Global Fund.”
Dr. Bente Mikkelsen, WHO Director for Noncommunicable Diseases: “We applaud the 14 countries’ achievement in reaching over one million women with services to prevent cervical cancer. WHO is pleased to work with Unitaid and its partners, demonstrating that, with innovative collaboration, the 90-70-90 elimination targets are achievable. Together, we must build on the momentum and support countries to bring services to scale, until women everywhere have access to the dignified care they deserve.”
Banner photo: A nurse in Rwanda explains cervical cancer screening to one of the many women who are now accessing critical preventive services. © Unitaid
About the World Health Organization’s cervical cancer elimination strategy
To eliminate cervical cancer as a public health problem, all countries must reach and maintain an incidence rate of below four per 100,000 women. This goal rests on achieving the following three targets by 2030, which align to WHO’s three strategic pillars:
- Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15
- Screening: 70% of women screened using a high-performance test by the age of 35 and again by 45
- Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed
About Unitaid’s cervical cancer programs in collaboration with CHAI and the SUCCESS project
Unitaid has invested nearly US$70 million to advance an effective package of tools and delivery models to support secondary prevention of cervical cancer in low- and middle-income countries. The projects are currently working in partnership with the governments of 14 countries – through CHAI in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe, and through the SUCCESS project in Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The SUCCESS project is implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC).
About Unitaid
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.
About CHAI
The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low- and middle-income countries. We work with our partners to help strengthen the capabilities of governments and the private sector to create and sustain high-quality health systems.
About Expertise France
Expertise France is a public agency and the interministerial actor in international technical cooperation, subsidiary of the Agence française de développement Group (AFD Group). As the second largest agency in Europe, it designs and implements projects that sustainably strengthen public policies in developing and emerging countries. Governance, security, climate, health, education… It operates in key areas of development and contributes alongside its partners to the implementation of the Sustainable Development Goals (SDGs). For a world in common.
About Jhpiego
Jhpiego, a global health non-profit and Johns Hopkins University affiliate, creates and delivers transformative health care solutions that save lives. For 50 years, Jhpiego has worked in partnership with 155 countries to build a strong health workforce and develop systems that improve health and transform the futures of women and their families. For the past three decades, Jhpiego has worked to eliminate cervical cancer in low and middle-income countries. Jhpiego’s approach mirrors the WHO Elimination Strategy goals, and begins with prevention through HPV vaccination, detection with HPV-DNA screening with a priority on primary and community settings, and early treatment for precancerous lesions. Through SUCCESS and in partnership with Expertise France and UICC, we have introduced this accessible, affordable, and achievable approach in the four project countries, Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines.
About UICC
The Union for International Cancer Control (UICC) is the largest and oldest international cancer-fighting organisation. Founded in Geneva in 1933, UICC has over 1,200 member organisations in 172 countries. It enjoys consultative status with the United Nations Economic and Social Council (ECOSOC) and has official relations with the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), the International Atomic Energy Agency (IAEA) and the United Nations Office on Drugs and Crime (UNODC). UICC has over 50 partners, including associations, companies and foundations committed to the fight against cancer. UICC is a founding member of the NCD Alliance, the McCabe Centre for Law & Cancer and the International Cancer Control Partnership (ICCP). UICC established the City Cancer Challenge Foundation in January 2019 and the Access to Oncology Medicines (ATOM) Coalition in 2022.
UICC’s mission is to both unite and support the cancer community in its efforts to reduce the global cancer burden, promote greater equity and ensure that cancer control remains a priority on the global health and development agenda. It pursues these goals by bringing together global leaders through innovative and far-reaching cancer-control events and initiatives, building capacities to meet regional needs and developing awareness campaigns.
Media contact:
For more information and media requests:
Maggie Zander, Communications Officer, Unitaid
M: +41 79 593 17 74
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Corina Milic, Acting Director of Communication, Clinton Health Access Initiative
cmilic@clintonhealthaccess.org
Unitaid and global health partners reach 90% treatment target for women screened with cervical cancer in multi-country pilots
- Unitaid-funded implementation programmes in Burkina Faso, Côte d’Ivoire, Malawi, Nigeria, Philippines, Rwanda and Senegal are reaching 90% treatment targets for women identified with pre-cancerous lesions just two years after launch of WHO cervical cancer elimination strategy – seven years ahead of schedule
- Cervical cancer is highly preventable, yet poorly adapted tools and ineffective screening have left women in low- and middle-income countries – where nine out of 10 deaths occur – without access to life-saving prevention
- Implemented by the Clinton Health Access Initiative (CHAI) or the SUCCESS consortium (Expertise France, Jhpiego and the Union for International Cancer Control), programmes in seven countries are advancing an effective model of care ready for broad and urgent scale-up
- More than 50% of the women reached through the programmes in the seven countries have been screened with an HPV test, progressing towards a second WHO target to reach 70% of women with high-performance screening
- Pricing agreements secured through Unitaid investments have reduced costs for pre-cancer treatment devices by nearly 45% and HPV tests by nearly 40% and are widely available for global uptake
Geneva – Global health agency Unitaid and its partners have developed and implemented a highly effective package of tools and strategies for cervical cancer prevention. Project sites in seven countries are already exceeding the WHO target to treat 90% of all women identified with pre-cancerous lesions by 2030, just two years after the launch of the WHO Cervical Cancer Elimination Strategy (17 November 2020).
Funded by Unitaid and implemented in partnership with the Clinton Health Access Initiative (CHAI) and the SUCCESS consortium (Expertise France, Jhpiego and the Union for International Cancer Control), the programmes in Burkina Faso, Côte d’Ivoire, Malawi, Nigeria, Philippines, Rwanda and Senegal are demonstrating a life-saving cervical cancer prevention model poised for broader – and urgent scale-up.
These models integrate a package of preventive care using high-performance HPV screening and portable devices for treating pre-cancerous lesions into existing health structures to increase coverage and awareness. Implemented widely, the models can achieve the WHO target for pre-cancer treatment and contribute to averting nearly 65 million deaths from cervical cancer over the next century.
The programmes are also progressing towards a second WHO target to reach 70% of women with high-performing screening by age 35 and again by 45, with more than 50% of women screened within the Unitaid-supported programmes having received an HPV test. In addition, three in four women receiving HPV tests are opting for self-sampling, which circumvents pelvic examinations that can be a deterrent to screening, confirming this method’s promise to extend access to even more women.
HPV testing replaces a far less accurate, subjective screening method based on visual inspection of the cervix in countries that already have solid diagnostic network capacity. Hand-held, battery powered thermal ablation devices replace heavy cryotherapy containers that require compressed gas. These devices allow for treatment of pre-cancerous lesions in primary health centers and reduce treatment time to one to two minutes, compared to 15.
To facilitate uptake, pricing agreements secured by Unitaid and CHAI have reduced the cost of thermal ablation devices by nearly 45% and HPV tests by nearly 40%. However, field data from countries show that the overall cost of thermal ablation is nearly ten times less than cryotherapy per woman treated.
Cervical cancer is highly preventable when women have access to early detection and treatment. However, in low- and middle-income countries where nine out of 10 cervical cancer deaths occur, progress has been held back by a lack of awareness and financing, as well as high costs, ineffective screening methods, and poorly adapted treatment devices.
“Unitaid and partners have delivered the models and technologies to make cervical cancer elimination a reality,” said Dr Philippe Duneton, Executive Director of Unitaid. “Now it comes down to access for all women. We must see concerted urgent action from governments and partners to scale up these models and bring an end to cervical cancer for generations to come.”
“On this second anniversary of WHO’s cervical cancer elimination strategy, we applaud all those who are helping to make innovative technologies accessible, so that women everywhere can enjoy the fundamental right to healthcare that we all deserve,” said Dr Princess Nothemba (Nono) Simelela, WHO Assistant Director-General for Strategic Priorities and Special Advisor to the Director-General. “Unitaid and its partners are making a very important contribution to our collective mission – I hope even more supporters will take inspiration from the early progress and join us in the effort to scale up services.”
Unitaid is the largest funder of innovative tools to find and treat precancerous lesions in women living in low-resource settings with nearly US$70 million invested. Projects in 14 countries are developing models for cervical cancer prevention adapted to low- and middle-income countries’ needs.
ADDITIONAL QUOTES
“As the world marks the anniversary of WHO’s Cervical Cancer Elimination Strategy Launch, CHAI celebrates the incredible milestones achieved over the past three and a half years thanks to Unitaid funding. We are committed to working with governments to expand equitable access to lifesaving health services for women and provide affordable and effective tools to reach those most in need. This is crucial to accelerate our progress toward eliminating cervical cancer as a public health issue. We hope our success so far will inspire more countries and partners to implement programs to help protect the health of women and provide better access to crucial treatments.” – Joshua Chu, Executive Vice President, Vaccines and Non-Communicable Diseases, CHAI
“The fight against cervical cancer is a fight against inequalities. Cervical cancer disproportionally affects women in limited-resources countries as well as women with disadvantaged social-economic status in high-income countries. Women living with HIV have a six-fold increased risk of developing cervical cancer compared to women without HIV. Despite being identified as an AIDS-defining disease in 1993, little has been done to address the need for cervical cancer prevention for women living with HIV. With Unitaid’s support, the SUCCESS project works on supporting governments and civil societies in lower- and middle-income countries to join forces of cancer and HIV national programs and communities. We focus on exploring people-centered and integrated interventions suitable for local contexts. Expertise France, through L’Initiative, is also contributing to this synergy by financing technical assistance, implementation, and operational research projects addressing HIV and HPV coinfections.” – Dr Lisa HUANG, SUCCESS Project Director, Expertise France
“We are seeing incredible progress on introduction and adoption of new secondary prevention approaches since the launch of the WHO Elimination strategy. This innovations journey underscores that healthcare system thinking is critical to see increased gains towards the elimination targets, and see cervical cancer prevention integrated and financed into routine women’s health and HIV services, and ensure the necessary communications, training, supply chain, and laboratory systems to scale and sustain this progress. Jhpiego continues to support government partners, providers, and communities to increase women’s access to prevention and treatment, and is thrilled over the progress with self-sampling for HPV.” – Tracey Shissler, Implementation Director, SUCCESS, Jhpiego
“The progress towards eliminating cervical cancer highlights what can be achieved in all income settings through effective financing, political will and on-the-ground expertise. In order to ensure that the gains made are secured for the long term, UICC will continue to work with and support its global network of member organisations and civil society more generally to fulfil their vital role in advocacy and hold governments to account.” – Dr Kirstie Graham, Director, Capacity Building, UICC
NOTES FOR EDITORS
Cervical cancer statistics:
- A woman dies every two minutes from cervical cancer
- Nine out of ten cervical cancer deaths worldwide occur in low- and middle-income countries
- Women living with HIV are six times as likely to develop cervical cancer
- For every 1 million women screened and treated, 200 to 300 cases of cervical cancer will be averted; for every 1 million women living with HIV screened and treated, several thousand cases of cervical cancer will be averted
- Achieving the WHO cervical cancer elimination targets by 2030 would result in over 62 million cervical cancer deaths averted by 2120
WHO targets:
To eliminate cervical cancer as a public health problem, all countries must reach and maintain an incidence rate of below four per 100,000 women. Achieving that goal rests on three key pillars and their corresponding targets:
- Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15
- Screening: 70% of women screened using a high-performance test by the age of 35 and again by 45
- Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed
About Unitaid’s cervical cancer programmes
Unitaid has invested nearly US$70 million to advance an effective package of tools and delivery models to support secondary prevention of cervical cancer in low- and middle-income countries. The projects are currently working in partnership with the governments of 14 countries – through CHAI in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe, and through the SUCCESS project in Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The SUCCESS project is implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC).
Media contacts
Hervé Verhoosel, Spokesperson Unitaid, mobile/whatsapp +33 6 22 59 73 54, verhooselh@unitaid.who.int
Corina Milic, CHAI, cmilic@clintonhealthaccess.org
Next generation pulse oximeters have great potential to reduce maternal and child mortality, PATH and Unitaid report says
A technology and market landscape report by PATH and Unitaid
To date, maternal and child mortality rates remain unacceptably high. In 2020, still over 5 million children under 5 years of age died, mostly in low- and middle-income countries, and mostly from conditions that are preventable or treatable, such as pneumonia, diarrhea, malaria and preterm birth complications.
To reach maternal and child global health targets by 2030[1], equitable access to innovative devices that have the potential to support health care workers in low-resource settings as they make decisions and provide fit-for-purpose treatment solutions, is urgently needed.
Pulse oximeters (POs) are noninvasive devices that measure blood oxygen saturation and pulse rate. They are used to help health care workers detect hypoxemia – a low level of oxygen in the blood – and to know how much oxygen to administer to patients. Detecting hypoxemia can allow timely treatment with oxygen therapy and save hundreds of thousands of lives each year.
The PATH-Unitaid technology and market landscape report, launched today, reviews the nascent global market for the next generation of pulse oximetry – multimodal POs.
These devices expand the features of standard POs by collecting additional clinical measurements, such as respiratory rate, temperature, and/or haemoglobin integrated into a single device that is appropriate for use in low-resource settings. These promising products can provide objective measurements to caregivers, via the same device and at the same time, to support clinical decision-making and ultimately save lives.
The report analyzes existing and emerging products and aims to assess their potential to improve screening for various illnesses that affect maternal and child health in low- and middle-income countries.
The report also examines market and technological challenges that hamper the adoption, scale-up and wide access in low-resource settings to these potentially lifesaving tools and maps out opportunities to overcome barriers limiting equitable access, including issues related to quality, availability, affordability, demand and supply.
Multimodal POs that are affordable, high-quality, and appropriately designed have the potential to achieve meaningful impact.
In addition to reducing mortality, multimodal POs could further optimize efficient use of resources and reduce the overall strain on health systems by minimizing the need for costly testing, strengthening referral decisions, and reducing unnecessary hospitalizations, intensive therapy, and overuse of antibiotic treatments.
In its work to address fever management and promote the adoption and scale-up of POs in primary health care, Unitaid has a portfolio of two complimentary grants for this purpose. Namely, Améliorer l’Identification des Détresses Respiratoire chez l’Enfant (AIRE) led by the Alliance for International Medical Action (ALIMA) and Tools for Integrated Management of Childhood Illness (TIMCI), led by PATH.
As part of the broader TIMCI project, PATH is currently initiating an evaluation and operational research study to assess performance and feasibility of using these tools by primary health care providers in Kenya, Senegal, Tanzania, and Uttar Pradesh, India.
Over the past four years, Unitaid and PATH have worked together to expand access to high-quality POs and clinical decision support algorithms to enable primary health care workers to better identify severely ill children and refer them for appropriate treatment without delay. The COVID-19 pandemic has brought the need for reliable access to such devices as part of sustainable and equitable oxygen delivery system even more to light.
- Access the Next Generation Pulse Oximeters Technology and Market Landscape here
[1] Sustainable Development Goal 3: Target 3.1, By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Target 3.2, By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under‑5 mortality to at least as low as 25 per 1,000 live births.
Related projects and publications:
For more information:
Sarah Mascheroni
mascheronisa@unitaid.who.int
For media requests:
Maggie Zander
Communications officer
M: +41 79 593 17 74
zanderm@unitaid.who.int
