Rwanda, Kenya, 5 others get to share $33m grant
Friday May 31 2019
A doctor obtaining a cervical smear specimen of cells for examination in a laboratory. Cervical cancer in Africa accounts for 22 per cent of all cancers in women and 12 per cent of all newly diagnosed cancer in men and women every year. PHOTO | ADAM GAULT
Rwanda and Kenya are among six African countries and India to benefit from a $33 million Unitaid-Clinton Health Access Initiative grant that has been awarded to Geneva-based Unitaid in its fight against cervical cancer.
The two countries join South Africa, Zambia, Malawi, and Nigeria, where Unitaid will implement a two and-a-half-year anti-cervical cancer project from July, combining AI, affordable treatment and screening in the fight against cervical cancer. The project will also extend to India.
It 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.
“The use of artificial intelligence in cervical cancer screening will be a game-changer,” said Unitaid executive director Lelio Marmora.
Women living with HIV have four to 10 times greater chance of developing cervical cancer when infected with HPV than HIV-negative women.
More than 75 per cent of cervical cancer incidence occurs in Africa and east of the continent bears the highest burden.
Kenya, Uganda and Tanzania bear the brunt of misdiagnosis, high cost of treatment and late presentation to hospitals.
It costs $1,720 to $7,590 to treat cervical cancer without surgery in Kenya and $6,720 to $12,500 if an operation is carried out, says the National Cancer Control Programme.
WHO estimates that HPV infections cause about 68,000 cases of cervical cancer in Africa annually. These figures are conservative because of weaknesses in health information systems and cancer registries in the continent.
Cervical cancer in Africa accounts for 22 per cent of all cancers in women and 12 per cent of all newly diagnosed cancer in men and women every year.
Routine screening
In Africa, 34 out of every 100,000 women are diagnosed with cervical cancer and 23 out of 100,000 women die from cervical cancer every year.
This figure compares with seven out of every 100,000 women diagnosed with cervical cancer and three out of 100,000 women dying of the disease annually in North America.
In Africa, most of the women are diagnosed at advanced stage of cancer a phenomenon associated with poverty.
“There is a need to integrate cancer control programmes with existing primary sexual and reproductive healthcare services, strengthen collaboration and improve public health awareness,” said WHO regional director for Africa Dr Matshidiso Moeti.
She said there is a safe and effective vaccine that has potential to prevent one-third of cervical cancer cases. Two HPV vaccines certified safe by WHO are intended for use in girls aged nine to 13 years.
It is important that the vaccine be administered before exposure to HPV. Routine cervical cancer screening and early treatment can prevent up to 80 per cent of cervical cancers.
WHO recommends screening for all women aged 30 to 49 to identify precancerous lesions. HPV vaccination is vital but does not replace the necessity of cancer screening and early treatment.
Challenge
However, the absence of national cervical cancer screening and treatment programmes is a major problem in Africa.
“In many parts of Africa, cervical cancers are not identified or treated until advanced stages due to insufficient access to reproductive healthcare services, effective screening and early treatment,” said Dr Moeti.
The cost of colposcope ($10,000 to $20,000) makes its use in Tanzania prohibitive. VIA is therefore is performed without magnification at the primary and secondary health settings. This makes interpretation of VIA subjective.
“The problem with implementing VIA at the primary health setting is that health worker density in Tanzania is dire at 1 physician per 45,000 persons and 1 community health worker per 2,800 persons,” said Dr Ramanujam.
She said further training is needed for community health workers to do speculum based exam and interpretation requiring as much as $30 per woman as uneven results lead to greater number of women that are overcalled as VIA positive.