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Comprehensive Cervical Cancer Control: Strength of working in Partnership

Comprehensive Cervical Cancer Control: Strength of working in Partnership. Dr. Bulbul Sood Country Director, Jhpiego /India . COMPREHENSIIVE PREVENTIION OF CERVIICAL CANCER Summit organized by ASSOCHAM 7th November, 2013, New Delhi. PRIMARY PREVENTION.

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Comprehensive Cervical Cancer Control: Strength of working in Partnership

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  1. Comprehensive Cervical Cancer Control: Strength of working in Partnership Dr. Bulbul Sood Country Director, Jhpiego/India COMPREHENSIIVE PREVENTIION OF CERVIICAL CANCER Summit organized by ASSOCHAM 7th November, 2013, New Delhi

  2. PRIMARY PREVENTION • HPV vaccines: Two prophylactic HPV vaccines -Gardasil ( quadrivalent vaccine, HPV genotype 6,11,16,18 ), - Cervarix (bivalent vaccine, HPV genotype 16,18) • Vaccine would protect woman against common types of HPV. • WHO recommendations support HPV vaccination of young adolescent girls ( 9 or 10 through 13 years of age) prior to onset of sexual debut • The vaccines do not clear existing HPV infections, or treat HPV related diseases

  3. Considerations for Introducing HPV Vaccine • Affordability • Healthcare infrastructure • Capacity to initiate and sustain vaccination • Cost effectiveness • Cultural Acceptability • Political Will • Public Support • Capacity for secondary prevention-screening and treatment Agnosti and Goldie, 2007

  4. Cervical cancer remains a major public health problem in many developing countries Cervical cancer is preventable Cervical cancer death is unnecessary HPV vaccines not therapeutic Effective, safe, low-cost out-patient treatment of precancerous lesions has been available for many years Available and accepted screening methods are not practical or accessible to the majority of women living in many countries Why Is a New Secondary Prevention Approach Needed?? Source: Blumenthal 1994; Gaffikin 1997.

  5. Effective Cervical Cancer Prevention Program: • An appropriate test is not enough • Effective service delivery system is Essential • Good test coverage • Appropriate management of screen positives • Limit loss to follow-up • Reasonable treatment cost

  6. Group Education Group Education Key Recommendations - ONE Every woman has the right to cervical screening at least once in her lifetime. The optimal age for screening is between 30 and 45 years old.

  7. TWO Organized Screening linked to Treatment Access is key to preventing cervical cancer

  8. THREE Screening Technology + Access to Effective Treatment = most effective secondary prevention strategy

  9. FOUR • VIA and Cryotherapy can be provided at point of care by trained midlevel providers. • Cryotherapy when conducted by competent providers is safe and results in cure rates of 85%* or greater.

  10. FIVE Over-treatment with cryo-therapy is acceptable because cryo-therapy is both curative and protective.

  11. SIX Women, their partners, communities, civic organizations and the health sector must be engaged in planning and implementing services.

  12. SEVEN For maximum impact, programs require effective training, supervision, and continuous quality improvement mechanisms.

  13. EIGHT Additional work needs to be done to develop rapid, user-friendly, low cost HPV tests and to improve cryotherapy equipment. Cryo-pop: Jhpiego is working in collaboration with CBID to develop a more afordable, practical and simpler equipment to delivery cryotherapy.

  14. Long-Term Impact of VIA screening • Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial (Lancet 2007; 370:398-406) • Published by group from International Agency for Research on Cancer (IARC) • KEY FINDINGS: • Cervical cancer burden was reduced by a single round of VIA screening. 25% reduction in incidence and 35% reduction in mortality. • All-cause mortality was significantly reduced in the intervention group compared to the controls. • VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries.

  15. SINGLE VISIT APPROACH - Jhpiego advocates for the Single Visit Approach (SVA) in low resource settings, using Visual Inspection with Acetic Acid (VIA) as a screening method

  16. Single Visit Approach Treat Immediately Cryotherapy Refer for LEEP

  17. Jhpiego Country Experience CURRENT PROGRAMS • BURKINA FASO • COTE D’IVOIRE • KENYA • MOZAMBIQUE • UGANDA • TANZANIA • PERU • THAILAND • PHILIPPINES

  18. TAKE HOME MESSAGES (1) • LOOK BEFORE YOU LEAP- ASSESSMENT CRITICAL • BUILD CAPABILITY- TRAIN, SUPERVISE & MONITOR • DEVELOP SERVICE PROVISION CAPACITY • MONITOR AND EVALUATE PROGRESS • PREPARE AND BUDGET FOR SCALE UP • EXPAND PILOT SITES AND SCALE-UP NATIONALLY • DISSEMINATE SUCCESS

  19. TAKE HOME MESSAGES (2) SCALING-UP SCREENING • Implement Sustained Organized Screening • Target All Eligible Women for Screening at Regular Intervals • Design service delivery model to adapt to organized screening • Offer free screening, treatment and automatic referral • Sustain a strong link from community to referral

  20. ADVOCACY • Identify and Nurture Support from Stakeholders • Professionals • Public Sector • Civil Society • Organize action group to champion Cervical Cancer Prevention • Establish a network of multi-sectoral advocates • Review/Develop policy and guidelines

  21. LET NO WOMAN BE LEFT UNSCREENED OR UNTREATED

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