A Cervical Cancer Free Africa: Regional Solu4ons for Las4ng Change

Transcription

1 A Cervical Cancer Free Africa: Regional Solu4ons for Las4ng Change Cervical Cancer Ac4on World Cancer Day Advocacy Webinar January 16, 2013 Dr. Mike Chirenje, University of Zimbabwe (Moderator) Dr. Jean- Marie Dangou, WHO/AFRO Dr. Emmanuel Mugisha, PATH Uganda Dr. Sharon Kapambwe, Center for Infec4ous Disease Research, Zambia Miss Anne Korir, Kenya Cancer Associa4on

2 How to hear the webinar audio The audio for this event is being transmiyed over your computer. If you are having trouble with the audio, please check that your computer speakers are on. You will hear music before the webinar begins. If you are unable adjust your se[ngs, please send a message to us using the chat func4on on your ReadyTalk screen. We will either send you a dial in number or arrange for an operator to call you. *** During the call, please send speaker ques4ons to Sarah@CervicalCancerAc4on.org or through the chat on your ReadyTalk screen. Thank you!

3 Governing Council: ª Advocacy coali4on of 1,200 organiza4ons and individuals ª Founded by global health organiza4ons represen4ng a broad range of cons4tuencies ª Focus on comprehensive programs: screening and treatment of adult women + vaccina4on of girls Goal: Expedite global availability, affordability and accessibility of new cervical cancer preven4on tools and approaches

4 Dr. Mike Chirenje Professor University of Zimbabwe Harare, Zimbabwe

5 Dr. Jean- Marie Dangou Regional Advisor for Cancer Preven4on and Control WHO Africa Regional Office Brazzaville, Congo

6 Dr. Emmanuel Mugisha Country Manager PATH Uganda Kampala, Uganda

7 Dr. Sharon Kapambwe Program Head African Centre of Excellence for Women s Cancer Control Lusaka, Zambia

8 Ms. Anne Korir Chairperson, Kenya Cancer Associa4on Director, Nairobi Cancer Registry Nairobi, Kenya

9 Connec3ng about Cervical Cancer Ac3on Webinar January 16, 2013 A cervical cancer free Africa: Regional solu7ons for las7ng change Dr. Jean- Marie Dangou Regional Advisor for Cancer Preven3on and Control WHO Regional Office for Africa

10 Regional burden of Cervical Cancer l ,000 diagnosed cases - 50,000 deaths l 200 million women aged >= 15 years at risk l Risk factors - Early marriage, Early first sexual intercourse; Multiple sexual partners; Multiparity; Link with AIDS; History of STD; Tobacco; Vitamin deficiency l Human Papilloma Virus (HPV) = causal agent ( 16 & 18 for over 70% Cancer cases) l Issues and Challenges

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12 Inequity of Cervical Cancer in the Region Age- standardized incidence rates per 100,000

13 Inequity of Cervical Cancer in the Region 20 countries with highest rates

14 Vulnerability of women living with HIV to Cervical cancer Cervical cancer HIV

15 WHO Comprehensive Cervical Cancer Preven7on and Control PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION Girls 9-13 yrs HPV vaccina3on From 10 years old and onward Health educa3on and services, e.g. to: ü Sexual health educa,on tailored to the age group ü Provide contracep,ve counseling and services including condoms ü Prevent tobacco use and support cessa,on Women > 30 years of age Screening and treatment as needed screen and treat with low cost technology VIA followed by cryotherapy HPV tes3ng for high risk HPV types (e.g. types 16, 18 and others) All Women as needed Treatment of invasive cancer at any age Abla3ve surgery Radiotherapy Chemotherapy

16 Immuniza7on & New screening/early treatment approaches l Lifelong sexual abstinence / HPV vaccination l HPV vaccines HPV vaccine licensure status, March 2010 Quadrivalent (22) Bivalent (15) Botswana, Burkina Faso, CAR, Cameroon, Chad, Congo, DR Congo, Cote d Ivoire, Equatorial Guinea, Ethiopia, Gabon, Guinea, Kenya, Malawi, Mali, Mauritania, Mauritius, Nigeria, South Africa, Tanzania, Togo, Uganda Congo, DR Congo, Burkina Faso, Cote d Ivoire, Gabon, Ghana, Kenya, Mali, Mauritius, Namibia, Nigeria, Tanzania, Senegal, South Africa, Uganda l WHO Position Paper l Anti HPV immunization Programmatically feasable Financially affordable and sustainable

17 Immuniza7on & New screening/early treatment approaches Conven3onnal Pap s smear VIA/VIL Hybrid Capture 2 DNA test (hc2) HPV rapid DNA Test

18 Next steps: roll out and capacity building l Cervical Cancer - an entry point for an integrated and holistic Cancer Prevention and Control. l Ideal outcome: HPV vaccine and adolescent health Screening and Treatment Fewer suffering and female deaths Organizing Diagnosis and Treatment Services. l Collaboration and partnership between Governments and other stakeholders l The engagement of the international community on this issue could result in one of the most significant easy wins in global public health today.

19 Next steps: roll out and capacity building l Integrated and comprehensive cervical cancer prevention and control plans l Equitable access and affordable comprehensive Cervical Cancer prevention l Cervical cancer screening and treatment coverage l Monitoring and Evaluation l Surveillance - Information systems and cancer registries

20 Concluding thoughts l HPV vaccination l Communication & education l Comprehensive Cervical cancer Prevention and Control plans WHO resources available at: noncommunicable_diseases/ documents/cervical_cancer_meeting/ en/ Thank you

21 Lessons learned from PATH projects and using these lessons to scale up con9nent wide cervical cancer preven9on efforts A cervical cancer free Africa: regional solu9ons for las9ng change Wednesday, 16 January 2013 (17h00 Kampala, Uganda) Emmanuel Mugisha, MPH, PhD Country Manager Uganda

22 Background of PATH demonstra6on projects Uganda Vietnam Hanoi Peru Nakasongola India Ibanda

23 Brief background on HPV vaccina6on in Uganda Prepara6ons started in 2006 with government and stakeholder involvement Undertook forma6ve research early on. This guided communica6on and delivery strategies Designed delivery strategies based on the results of the forma6ve research: Strategy 1: Delivery of the vaccine through Child Days Plus ac6vi6es (selec6on of target girls by age). Strategy 2: Delivery of the vaccine as a standalone through schools (selec6on of target girls by grade/class). PATH, Ministry of Health (EPI division), and local districts implemented vaccina6ons in ATer implementa6on, evalua6ons were conducted to understand coverage, acceptability, feasibility, and cost of each strategy.

24 Lessons Learned: Uganda HPV Demonstra6on Project Exis6ng MoH EPI structures from na6onal to district level are sufficient to deliver HPV vaccine if well coordinated and well planned. Adequate prepara6on and well coordinated efforts are essen6al in ensuring success. Schools are good venues for reaching young adolescent girls but require: Partnership with MOES (teachers) in planning & implementa6on. Exis6ng health system with a func6onal community health outreach program. High school a\endance rates among the target popula6on. High vaccina6on coverage can be a\ained when girls are selected and vaccinated by school grade/class compared to age- based strategy. Easy follow- up and comple6on. Less disrup6ons to school ac6vi6es. Each strategy has pros and cons. This led to a hybrid in Uganda vaccinate during child days but select by grade.

25 Cervical cancer preven6on in Uganda: A comprehensive approach Need for a comprehensive approach because not everyone will benefit from HPV vaccina6on. PATH also has been involved in secondary preven6on ac6vi6es, including: Se`ng up screening and treatment sites in government health facili6es Demonstra6ng new screening technologies eg. HPV DNA tes6ng (START UP project) Training master trainers for screening and treatment Development of na6onal strategic plan for cervical cancer preven6on and control. Uganda s plan for phased introduc6on of HPV vaccine leading to GAVI support.

26 Screening technologies for low resource se`ngs - VIA and HPV DNA tes6ng What do we need in an ideal screening test? High sensi6vity High specificity Accessible for low- income areas QIAGEN High acceptability among woman The HC2 Test The carehpv Test QIAGEN

27 Using the Uganda lessons to scale up con9nent- wide cervical cancer preven9on efforts Sharing experiences, tools, and materials across the region Materials and tools for implemen6ng HPV vaccina6on that only need adap6on for other country use. Materials and tools for screening and treatment of precancerous lesions. Providing technical exper6se on both HPV vaccina6on and screening and treatment through. On- site mee6ngs with country teams Online support, teleconferences and s Hos6ng delega6ons from other countries to Uganda

28 Materials for Na6onal- Level Planning and Implementa6on Strategic plan for cancer preven6on and control. Documents on step- by- step HPV vaccina6on implementa6on. Documents of lessons learned. Mobiliza6on and sensi6za6on materials. Publica6ons: peer- reviewed and others. Tools for evalua6on of demonstra6on projects.

29 PATH regional support for HPV vaccina6on HPV vaccine is one of the latest vaccines available to GAVI eligible countries There are two op6ons for the GAVI applica6on A demonstra6on project in a few selected sites A na6onal roll out program PATH has received funds to offer technical support in the planning and implementa6on of demonstra6on projects for GAVI- eligible countries, including: Prepara6on of GAVI applica6ons Development of implementa6on plans DraTing or review of communica6on and training materials Sharing of exis6ng tools and other resources Design of evalua6on strategies Page 9 1/24/13

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31 Other Online Resources

32 Moving to Ac+on: The Zambian Experience Dr. Sharon Kapambwe Program Head African Centre of Excellence for Women s Cancer Control

33 Cervical Cancer in Zambia World s second highest cervical cancer incidence 52.8/100,000 (IARC) Most common cancer diagnosed in adults (38%) 80% cases advanced Lack of access to screening and treatment >95% women never had a pelvic exam

34 Cancer Control Efforts in Zambia 2006: Cervical cancer screening project started CollaboraWon of Ministry of Health and Centre for InfecWous Disease Research in Zambia (CIDRZ) Almost 100,000 women screened Now a nawonal program led by government Treatment: surgery and chemoradiawon HPV vaccinawon demonstrawon program in girls starwng in February 2013

35 Global training / Globally scalable model Trained over 200 healthcare professionals from 13 countries

36 Accessing Global Resources Pink Ribbon Red Ribbon (PRRR) - partnership designed to leverage public and private investments to fight cervical and breast cancer President George W. Bush visited Zambia twice in 6 months launched PRRR in Zambia built first women s cancer control clinic

37 PRRR support for Zambian women s cancer control efforts PEPFAR - NaWonal expansion of cervical cancer prevenwon services Susan G. Komen for the Cure - CoaliWon of women s cancer control advocacy groups - Support training of breast cancer control specialists Merck - Support for HPV vaccinawon demonstrawon project - 50,000 girls Glaxo Smith Kline - Support for HPV vaccinawon demonstrawon project - 10,000 girls - PalliaWve care support George W. Bush Ins+tute - Support point- of- care telemedicine placorm Na+onal Breast Cancer Founda+on - Support for Health PromoWon Manager for five years

38 Top ten myths and misconcep+ons about cervical cancer among previously unscreened women in Lusaka, Zambia Chirwa, Mwanahamuntu, Kapambwe et al. Global Health PromoWon 2010

39 Engaging the Community Use exiswng social and health structures to involve the community o TradiWonal marriage counselors o TradiWonal chiefs o Church leaders Use of social media e.g. facebook Use of prominent people in society to sensiwse Zambian First Lady- Dr. ChrisWne Kaseba- Sata Cabinet Ministers wives

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41 Lessons Learnt Build and promote local/government leadership Locate within government infrastructures Use appropriate technology Build systems approach Build surgical oncology services Apply innovawve business models for sustainability

42 LEVERAGING GLOBAL TARGETS FOR NATIONAL LEVEL CHANGE Anne Korir, Chairperson, Kenya Cancer Association

43 Situation in Kenya Although Pap smear tests, VIAA and VILI are available in some hospitals not all women can access the services especially in rural areas. Cervical cancer patients are diagnosed late, Limited number of trained healthcare personnel There is still low awareness of cervical cancer and HPV vaccine Even in places where women are educated and aware of the disease, cost is still a limiting factor

44 Use of NCD framework in cancer control Kenya Cancer Association is a non profit organization that seeks to reduce cancer incidence and mortality Through advocacy and mobilizing key stakeholders we developed a National Cancer Control Bill which is now an Act of Parliament The Act seeks to establish regional cancer centres to undertake screening for early detection, education for prevention, diagnostic services, treatment, and palliative care. We continue with advocacy to ensure its implementation We have partnered with various organizations to undertake advocacy in the community, especially in rural areas to raise awareness on prevention and benefits of early diagnosis A media training was held where several media houses participated, this has improved on media reporting

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46 Teaching about Cervical and breast Cancer to women in Gatundu, a rural village in Kenya

47 Partnership/collaboration in prevention of cervical cancer The American Cancer Society through the Meet the Targets program supports national advocacy efforts in key priority countries ACS through the Meet the Targets Program partnered with Kenya Cancer Association to look at the possibility of integrating Non Communicable Diseases education and screening in HIV testing centres Through this study we will develop an evidence based strategy to integrate these services into existing HIV testing centers in Kenya This model can be adopted in HIV testing centre across the country We encourage organizations like the Pink Ribbon Red Ribbon (PRRR), GAVI to support this initiative Fundraising activities have been undertaken to raise funds towards screening and treatment of cancer patients

48 Dispel myths and misconceptions about cervical cancer Commemorate World Cancer Day ;4 th Feb. 1. UICC myths 2. Other common myths in Africa Cancer is a curse, witchcraft Is equated to AIDS - is a death sentence. Is contagious Is a woman's problem We have partnered with schools to use art to demystify the myths surrounding cancer

49 Conclusion Affordable screening for cervical cancer is feasible and effective in LMICs There is a need to take immediate action to reduce the burden of cervical cancer in Africa We are grateful to the international community for coming on board to support We need to consolidate our efforts and undertake aggressive advocacy to make an impact in Africa We need concerted push by key stakeholders: International organizations, African governments, all health professionals, policy makers, politicians, First ladies of Africa - all have a role to play

50 DISCUSSION To ask a ques*on you can: 1) Send your ques*on via chat if you are logged into the webinar interface. 2) your ques*on to Sarah@CervicalCancerAc*on.org The moderator will pose as many of your ques*ons as possible to the panelist during the discussion period.

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52 UICC World Cancer Day 2013 toolkit

53 UICC Advocacy Toolkit

54 Resources