Closing the care gap: Reflections on World Cancer Day

Cervical cancer is one of the most preventable types of cancer but continues to be a leading cause of disease and death for women in low- and middle-income countries (LMICs). More than 300,000 women die of cervical cancer each year, with more than 90 percent of deaths occurring in LMICs.

Human papillomavirus (HPV) vaccination and effective screening and treatment services for pre-cancerous lesions offer the opportunity to eliminate cervical cancer as a public health problem. The World Health Organization (WHO) is leading a global effort to scale up interventions to put elimination within reach in the foreseeable future. With support from Unitaid, CHAI has been working since 2019 to expand access to tools to scale up screening, and treatment services for women in LMICs.

The project has reduced HPV test prices by more than 40 percent and cut the cost of thermal ablation and loop electrosurgical excision procedure (LEEP) devices to treat pre-cancerous lesions by 50 percent and 20 percent respectively. More than 230,000 women have been screened across CHAI partner countries, including at least 71,000 women screened with HPV tests, and the number of women receiving appropriate treatment has substantially increased. Partner governments have also established hundreds of screening and treatment sites that will now form the backbone of scale-up efforts, providing in-country models and expertise. By demonstrating effective delivery models for screening, treatment, and linkages to a full continuum of care using existing tools, the project is achieving near-term public health impact and laying the groundwork for scale-up of new and more affordable, point-of-care screening technologies when they become available.

Parallel to this effort, CHAI is supporting the development of an artificial-intelligence-based screening method that can run on a standard cell phone and be used as a diagnostic aid to healthcare workers. The goal of the project is to offer a highly effective and affordable screening method that could enable scale up at the primary healthcare level within government budgets using automated visual evaluation (AVE) as an aid to health workers conducting visual screening. In 2022, CHAI will coordinate a targeted set of effectiveness studies to evaluate the accuracy of AVE in a range of field settings. This technology has the potential to serve as another critical tool in the global effort to eliminate cervical cancer as a public health problem.

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