Dr. Sharon Kapambwe National Coordinator Cancer Prevention Ministry of Health Zambia. A Zambian Approach to Cervical Cancer Prevention

Transcription

1 Dr. Sharon Kapambwe National Coordinator Cancer Prevention Ministry of Health Zambia A Zambian Approach to Cervical Cancer Prevention

2 About Zambia A country of 15 million people Life expectancy 48 years Per capita income $1,721 70% live below poverty 56% live in rural areas HIV prevalence 13.3%

3 Context-2003 Physician patient ratio: 0.12/1, gynecologists in the nation No gynaecological oncology unit 6 pathologists in the public sector No cytologists Raging HIV epidemic (Adult HIV Prevalence 16.5%) No chemo radiation centre Cytology based screening doctor led No HPV vaccination Increasing cervical cancer cases Competing priorities

4 Gynecol Oncol 2006; 103: Suggestive of Cancer 19% Normal 6% ASCUS 17% HSIL 34% LSIL 23%

5 Programme Implementation, 2006 Integrated into two government operated public health clinics Government and CDC/PEPFAR supported Target HIV infected women

6 Programme Implementation, 2006 Nurse led, VIA based screen and treat platforms

7 Local solutions Horizontal integration of a cervical cancer prevention into existing infrastructure VIA as the main approach Local training program for nurses and doctors in VIA, Cryotherapy and LEEP Thermal coagulation recently introduced Introduction of innovation: electronic cervical cancer control ec3 Point of care data electronic data collection Distance consultation Monitoring and evaluation Continuing medical education Patient education

8 Cervicography

9

10 Prepared by Community Team ACEWCC 5/ 23/ 2013

11 Three Phase National Scale Up Transitioning to government 1 2 Provincial hospitals Nursing schools, functioning theatre VIA, Cryotherapy, LEEP District hospitals VIA, Cryotherapy +/ LEEP 3 Health facilities VIA, Cryotherapy

12 Outcomes Over 350,000 women screened for cervical cancer Outreach/mobile screening initiatives

13 ervical Cancer Screening inics in Zambia (2015) Nchelenge Chienge Kaputa MporokosoMpulungu Kawambwa Kasama Luwingu Mwense Mbala Mungwi Chinsali Nakonde Isoka Mansa Samfya Chilubi Chama Mwinilunga Solwezi Milenge Mpika Lundazi vuma alabo Zambezi Lukulu Mongu Kabompo Kaoma Mufumbwe Kasempa Mumbwa Itezi-Tezhi Lufwanyama 7 Masaiti Mpongwe Kapiri Mposhi Kabwe Urban Kabwe Chibombo Lusaka (12) Kafue Serenje Mkushi Nyimba Chongwe Luangwa Mambwe Petauke Chipata Katete Chadiza Key: hangombo Senanga Sesheke Namwala Mazabuka Monze Siavonga Choma Gwembe Kalomo Sinazongwe Kazungula Livingstone 1. Chililabombwe 2. Mufulira 3. Chingola 4. Kalulushi 5. Kitwe 6. Ndola Urban 7. Luanshya VIA only LEEP and VIA

14 Regional Training Program Trained over 300 healthcare professionals from 14 countries

15 Strategic plans NCDs Strategic plans Guidelines on NCDs Management of NCDs Training of health workers National Cancer Control strategic Costing of comprehensive cervical cancer care and control tool Prioritised four cancer (Breast, Cervix, Prostate and Retinoblastoma)

16 May 2013 LAUNCH OF HPV VACCINE

17 HPV Vaccination Third year vaccination in selected districts Over 30,000 girls got all three doses in first two years Targeted 20,000 in % coverage at second dose New partners and opportunities Strengthen school health programs for sustainability and reduced cost of delivery

18 Challenges in prevention Pathology services inadequate Reaching women in underserved areas HPV vaccination using limited adolescent services Dealing with the HIV infected adolescent girls Erratic and high cost of Nitrous Oxide for cryotherapy treatment of pre cancer Laptop computer, TV and camera Cumbersome for outreach programmes

19 Recommendations Molecular test Mass screening Point of care test Alternative treatment of pre cancerous lesions methods Thermal coagulation Platform for initiation of breast cancer screening/ncds (CBE) Implement market based strategy for sustainability (social Insurance) National Roll out of HPV vaccination with enhanced school health programme Integrated chronic disease care in primary health facilities

20 Thank you