One million women screened for cervical cancer in low-and middle-income countries
Over one million women in 14 low-and middle-income countries have been screened for cervical cancer through an integrated prevention program, delivered by country governments in collaboration with global health agency Unitaid, the Clinton Health Access Initiative (CHAI), and Expertise France as the lead of the SUCCESS project, in partnership with Jhpiego and the Union for International Cancer Control (UICC). Over 80 percent of women who have screened positive for cervical pre-cancer have received treatment.
This is part of a broader effort to develop scalable models for cervical cancer prevention that is adapted to lower income settings across Africa, Asia, and Latin America where nine in ten deaths from cervical cancer occur.
The program has seen countries train thousands of health workers and significantly expand the number of medical facilities offering life-saving screening and preventive treatment.
The program is designed around a package of high performing and cost-effective screening, preventive treatment, and planning tools and delivery methods, including:
- World Health Organization (WHO) tools to produce national costing plans for a prevention program using HPV testing, which identifies the leading cause of cervical cancer and replaces a less accurate screening method based on visual inspection of the cervix.
- Introducing self-sampling methods for HPV testing, which circumvent the need for pelvic examinations–a promising technique to increase participation in screening programs.
- Supporting integrated patient monitoring tools, connected to national databases, across many program countries.
- Introducing portable thermal ablation devices, which provide a simpler and more affordable method of treating pre-cancerous cells on the cervix compared to traditional cryotherapy machines.
- Engaging and supporting civil society organizations to raise awareness within their communities of the services available, and in advocacy—essential for sustainable and long-term progress.
Additionally, the program is supporting development of artificial intelligence-based assessment tools–an emerging innovation with the potential to improve accuracy of visual screening methods.
Since October 2019, programs in Burkina Faso, Côte d’Ivoire, Guatemala, India, Kenya, Malawi, Nigeria, the Philippines, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe have been developing and demonstrating successful implementation of this package of care. With the program’s support, more than 250,000 women have been screened in Kenya, more than 190,000 women have been screened in India, and more than 200,000 women have been screened in Nigeria over the past three years.
By November 2022, program sites in half of these countries were achieving the World Health Organization’s (WHO) target to ensure 90 percent of women who screen positive for pre-cancerous lesions receive preventive treatment—seven years ahead of schedule, thus demonstrating effective models at scale that are ready to be replicated in other countries and contexts.
According to WHO, approximately 600,000 new cases of cervical cancer are recorded each year, resulting in over 340,000 deaths. However, cervical cancer is highly preventable when women have access to early screening and preventive treatment. The risk of cancer is reduced, and health outcomes improved the earlier infection is diagnosed.
Philippe Duneton, Executive Director of Unitaid comments: “With one million women reached so far, Unitaid is pleased to see that this package of effective and affordable technologies and delivery models is proving successful in fighting cervical cancer in low- and middle-income countries. We now call on governments and partners to urgently scale up these models of care and reduce the burden of cervical cancer in LMICs, where nearly all deaths from the disease occur.”
As part of the program, Unitaid and CHAI negotiated substantial price reductions for HPV tests of approximately 40 percent to less than US$9 and achieved an approximate 45 percent reduction in the cost of thermal ablation devices.
Joshua Chu, Executive Vice President, Vaccines and Non-Communicable Diseases, Clinton Health Access Initiative adds: “Reaching one million women screened for cervical cancer through the Unitaid-funded program is a major milestone, and we recognise the efforts of the Ministries of Health to prioritise resources to ensure women have an equal chance to live healthy and fulfilled lives. However, more needs to be done to rapidly expand these services, avert 65 million more deaths from this preventable and treatable disease over the next century, and ultimately eliminate cervical cancer as a public health threat.”
Through its various outreach and education strategies, the SUCCESS project has been able to achieve a high level of acceptability of self-sampling in its four implementing countries. Indeed, nearly 88 percent of women screened used self-sampling.
Eric Fleutelot, Technical Director, Major Pandemics Unit, Health Department, Expertise France mentions: “The devotion of the Ministries of Health with whom we collaborate, through cancer control programs, as well as HIV programs, demonstrates the interest of the implementation of these innovative solutions. For our efforts to be sustainable, and thus be able to reach several million women, we need to bring in more financial partners to this fight. The SUCCESS project has been pursuing various avenues to secure and expand funding streams, such as through other partners like L’Initiative and the Global Fund.”
Dr. Bente Mikkelsen, WHO Director for Noncommunicable Diseases: “We applaud the 14 countries’ achievement in reaching over one million women with services to prevent cervical cancer. WHO is pleased to work with Unitaid and its partners, demonstrating that, with innovative collaboration, the 90-70-90 elimination targets are achievable. Together, we must build on the momentum and support countries to bring services to scale, until women everywhere have access to the dignified care they deserve.”
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NOTES TO EDITOR:
WHO cervical cancer elimination strategy
To eliminate cervical cancer as a public health problem, all countries must reach and maintain an incidence rate of below four per 100,000 women. This goal rests on achieving the following three targets by 2030, which align to WHO’s three strategic pillars:
- Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15
- Screening: 70% of women screened using a high-performance test by the age of 35 and again by 45
- Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed
About Unitaid’s cervical cancer programs in collaboration with CHAI and the SUCCESS project
Unitaid has invested nearly US$70 million to advance an effective package of tools and delivery models to support secondary prevention of cervical cancer in low- and middle-income countries. The projects are currently working in partnership with the governments of 14 countries – through CHAI in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe, and through the SUCCESS project in Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The SUCCESS project is implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC).
More information is available here.
Maggie Zander, Communications Officer, Unitaid
M: +41 79 593 17 74
Corina Milic, Acting Director of Communication, Clinton Health Access Initiative
The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low- and middle-income countries. We work with our partners to help strengthen the capabilities of governments and the private sector to create and sustain high-quality health systems. For more information, please visit www.clintonhealthaccess.org.
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.
About Expertise France
Expertise France is a public agency and the interministerial actor in international technical cooperation, subsidiary of the Agence française de développement Group (AFD Group). As the second largest agency in Europe, it designs and implements projects that sustainably strengthen public policies in developing and emerging countries. Governance, security, climate, health, education… It operates in key areas of development and contributes alongside its partners to the implementation of the Sustainable Development Goals (SDGs). For a world in common.
For more information: www.expertisefrance.fr
Jhpiego, a global health non-profit and Johns Hopkins University affiliate, creates and delivers transformative health care solutions that save lives. For 50 years, Jhpiego has worked in partnership with 155 countries to build a strong health workforce and develop systems that improve health and transform the futures of women and their families. For the past three decades, Jhpiego has worked to eliminate cervical cancer in low and middle-income countries. Jhpiego’s approach mirrors the WHO Elimination Strategy goals, and begins with prevention through HPV vaccination, detection with HPV-DNA screening with a priority on primary and community settings, and early treatment for precancerous lesions. Through SUCCESS and in partnership with Expertise France and UICC, we have introduced this accessible, affordable, and achievable approach in the four project countries, Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines.
The Union for International Cancer Control (UICC) is the largest and oldest international cancer-fighting organisation. Founded in Geneva in 1933, UICC has over 1,200 member organisations in 172 countries. It enjoys consultative status with the United Nations Economic and Social Council (ECOSOC) and has official relations with the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), the International Atomic Energy Agency (IAEA) and the United Nations Office on Drugs and Crime (UNODC). UICC has over 50 partners, including associations, companies and foundations committed to the fight against cancer. UICC is a founding member of the NCD Alliance, the McCabe Centre for Law & Cancer and the International Cancer Control Partnership (ICCP). UICC established the City Cancer Challenge Foundation in January 2019 and the Access to Oncology Medicines (ATOM) Coalition in 2022.
UICC’s mission is to both unite and support the cancer community in its efforts to reduce the global cancer burden, promote greater equity and ensure that cancer control remains a priority on the global health and development agenda. It pursues these goals by bringing together global leaders through innovative and far-reaching cancer-control events and initiatives, building capacities to meet regional needs and developing awareness campaigns.