CERVICAL CANCERCONTROL PROGRAMME IN MALAWI OVERVIEW FOR 2015 PROGRAMME PERFORMANCE

Transcription

1 CERVICAL CANCERCONTROL PROGRAMME IN MALAWI OVERVIEW FOR 2015 PROGRAMME PERFORMANCE

2 Burden of Cervical Cancer & its risk Commonest in women accounting for 45% of all cancers factors in Malawi Over 2,300 new cases per year (WHO HPV Centre) Over 1,600 women die of Ca Cx every year (WHO HPV Centre) Women aged at risk: 4 million HIV in women aged 15-49: 12.9% (DHS 2010) HPV prevalence: 33.6% (WHO HPV Center)

3 Malawi National Cervical Cancer Control Programme Was established in 2004 Prevention Interventions & Strategies Primary Prevention HPV Vaccine Demonstration Project successfully implemented in in 2 districts (Zomba & Rumphi) Year 1 Fully immunized: 86% Year 2 Fully immunized: 91% Secondary preventions Other efforts with positive impact on Ca cx risk factors Cervical Cancer screening using visual inspection with acetic acid (VIA)- about 130 functional screening sites Pap Smear- Pvt hosp and some CHAM (Malamulo Mission Hosp) Cryotherapy- 39 functional sites Cold coagulation- 11 sites Voluntary male medical circumcision (intensified with support from partners) HIV prevention and treatment- One of the best in southern Africa

4 HPV and Cervical Cancer Human Papilloma Virus (HPV) is major cause of Cervical cancer accounting for 95% of cases HPV also causes other anal-genital cancers (anal, vulval, vaginal and penile) and genital warts. There are over 130 subtypes of HPV. The ones known to cause cervical cancers are: HPV subtype: 16, 18, 31, and 45 account for 80% while 6, 33, 35, 39, 51, 52, 56, 58 and 59 account for 20% HPV subtype 6 and 11 cause genital warts HPV subtype 16 and 18 account for 70% Ca Cx

5 Primary Prevention: HPV Vaccine Cervalix Gardansil Type Bivalent Quardvalent HPV subtypes 16,18 6,11 (Genital warts) 16,18 (Ca Cx) Target group Girls: 9-13 years old Girls: 9-13 years old Administration IM IM Doses - 2 Vaccine schedule - 2-dose regimen at 0, 6 months Strategy - Sch-based, STD 4, All girls regardless of age. High coverage but expensive Facility-based, Cheap but coverage is likely to be very low

6 Malawi HPV Vaccine Sch-based Demo Project Zomba Rumphi Total No. Coverage No. Coverage No. Coverage Year 1: Target pop 1,292-4,292-6,222 Dose 1 1, , , Dose 2 1, , , Dose , , Year 2: Target pop 1,720-3,296-5,016 - Dose 1 1, , , Dose 2 1, , , Year 3:

7 Year 3: Schedule Zomba (scaled-up to the whole district) Rumphi (whole district) Dose Nov 2015 Target: Coverage In-Sch 15, % Out of Sch % Total 16, % Jan 2016 Dose 2 May/June 2016 July 2016

8

9 No. of women screened for Cervical Cancer: Year Number of women screened Number of women with VIA postive Number of women with VIA positive treated Number of women with advance cancer n %Coverage n % n % n % , , , , , , , , , , , , , Total 143,778 7, , ,

10 Trends in the no. of women screened for Cervical cancer:

11 Number of women screened by age and HIV status Total VIA Positive Suspect cancer VIA Positive or suspect cancer n % n % n % n % Age (years): <30 13, , , >45 7, All with known age 48, , , HIV status: Negative 21, , , Positive 6, Unknown 11, , All with HIV status data 38, , , ,

12 Key Issues & Challenges 1. Inadequate Cryo machines; 5 districts have no Cryo at all. VIA positive women eligible for Cryo are referred to the next site, hence only 40% were done- Ethical issue. 2. Inadequate trained providers (on average only 2/site and have other duties) 3. Inadequate funding for Community mobilization, M & E and quality control (supportive supervision bi-annual programme reviews)

13 Lessons learnt & Opportunities Primary (HPV vaccine) & Secondary ( Screen and Treat using VIA) Cervical Cancer prevention is feasible in Malawi Partners (WHO, UNFPA, UNICEF, BLM, PCI, SSDI, DREAM, Dignitas, Mission Hospitals & other NGOs) are supporting the National Programme The sustained high impact HIV interventions are beneficial to cervical cancer control

14 Recommendations/Way forward 1. Strengthen the screen & treat approach by scaling up Cryo sites and maintain their functionality 2. Strengthen linkage between VIA Clinic and ART Clinic aiming at screening at least 80% of women on ART 3. Strengthen capacity building by training new providers and re-fresh old ones. 4. Improve awareness on Cervical cancer at all levels: National level with stakeholders and suppliers e.g. suppliers of gas and Cryo suppliers Zonal level at quarterly reviews and supportive supervision DHMT Health workers Community 5. Strengthen the capacity for M & E, surveillance including data management

15 Thank you for your listening