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Advancing Cervical Cancer Screening in HIV-positive women (ACCHIVe) - The Cervical Cancer Prevention and Care Cascade

English title ACCHIVe - The Cervical Cancer Prevention and Care Cascade
Applicant Bohlius Julia
Number 177319
Funding scheme r4d (Swiss Programme for Research on Global Issues for Development)
Research institution Swiss TPH Universität Basel
Institution of higher education University of Basel - BS
Main discipline Public Health and Health Services
Start/End 01.10.2018 - 30.09.2022
Approved amount 600'000.00
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All Disciplines (2)

Discipline
Public Health and Health Services
Cancer

Keywords (4)

screening; Southern Africa; HIV/AIDS; cervical cancer

Lay Summary (German)

Lead
Verbesserte Monitoring Systeme um der Entstehung von Gebärmutterhalskarzinomen bei HIV-infizierten Frauen im südlichen Afrika vorzubeugen
Lay summary

Das Gebärmutterhalskarzinom lässt sich durch regelmässige Früherkennungsuntersuchungen und Behandlung von präkanzerösen Läsionen verhindern. In Ländern mit niedrigem und mittlerem Einkommen ist der Zugang zu Früherkennungsuntersuchungen jedoch häufig erschwert. Zwischen Ländern mit hohem und niedrigem und mittlerem Einkommen gibt es deshalb grosse Unterschiede: bei Frauen, die in Ländern mit niedrigem und mittlerem Einkommen leben, tritt das   Gebärmutterhalskarzinom sehr viel häufiger aus als bei Frauen, die in Ländern mit hohem Einkommen leben. Verursacher des Gebärmutterhalskarzinoms sind Humane Papillomviren (HPV). Frauen, die mit einer HIV Infektion leben, haben ein erhöhtes Risiko, sich mit HPV anzustecken und den Virus nicht kontrollieren zu können. Die Entstehung von präkanzerösen und kanzerösen Läsionen ist daher bei Frauen mit HIV Infektion höher als bei Frauen ohne HIV Infektion. In unserem Projekt wollen wir ein Monitoring System entwickeln, dass es erlaubt, den Zugang von Frauen mit HIV Infektion im südlichen Afrika zu geeigneten Früherkennungsuntersuchen im Rahmen der allgemeinen Patient Versorgung zu verbessern. Mit sozialwissenschaftlichen Methoden werden wir erheben, warum Frauen erschwerten Zugang zu Früherkennungsuntersuchen haben. Die Ergebnisse des Projektes werden Richtlinien zum Monitoring des Gebärmutterhalskarzinom-Screenings informieren. Das Projekt wird in enger Kollaboration mit Projektpartnern in Sambia sowie Südafrika, Simbabwe, Malawi und Mozambique durchgeführt.

Direct link to Lay Summary Last update: 21.01.2019

Responsible applicant and co-applicants

Employees

Collaboration

Group / person Country
Types of collaboration
International Agency for Research on Cancer (IARC) France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Cervical Cancer Prevention Program Zambia (CCPPZ) Zambia (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Centre for Infectious Disease Research in Zambia (CIDRZ) Zambia (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
International Epidemiology Databases to Evaluate AIDS (IeDEA), West Africa Burkina Faso (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
International Epidemiology Databases to Evaluate AIDS (IeDEA), East Africa Kenya (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
International Epidemiology Databases to Evaluate AIDS (IeDEA), Central Africa Burundi (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
International Epidemiology Databases to Evaluate AIDS (IeDEA) South Africa (Africa)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
12th International Conference on Cancer in Africa (AORTIC) Poster Indicators and targets for cervical cancer prevention in countries with the highest HIV burden: a review of policies. 05.11.2019 Maputo, Mozambique Bohlius Julia; Asangbeh Serra Lem;


Knowledge transfer events



Self-organised

Title Date Place
Stakeholder meeting: the Cervical Cancer Prevention and Care Cascade 30.10.2019 Johannesburg, South Africa

Communication with the public

Communication Title Media Place Year
Video/Film Fighting the 'female' cancer International 2019

Awards

Title Year
PhD student Serra Asangbeh received a Swiss Government Excellence Scholarship 2019
SSPH+ Science Flash Talk Award https://www.ispm.unibe.ch/about_us/news/ssph_scienceflashtalk_winner/index_eng.html 2019
Serra Asangbeh obtained a GlobalP3HS Fellowships in Public Health Sciences, funder: Marie Skłodowska-Curie Actions (Horizon 2020 - COFUND). 2018

Abstract

The disparity between high- and low-income countries in the incidence and mortality of cervical cancer (CC) is an increasing concern and a cross-cutting theme in sustainable development goals. In Southern Africa (SA), this disparity is exacerbated by high HIV prevalence. CC rates drop after effective screening programs are implemented, and these programs are growing more common in SA. These new programs must be evaluated to ensure they are efficient and make good use of scarce resources, so policy makers can make evidence-based decisions about expanding them. To address this concern we aim to develop an evidence-based Cervical Cancer Prevention and Care Cascade to monitor scale-up of CC screening across ART programs in SA that already integrate CC screening services. We propose a Cascade analogous to that for HIV care; the HIV Cascade is widely accepted in international HIV policy and research. We will expand this model to CC in HIV-positive women, which has not been done before.To develop the Cascade, we will break the continuum of CC screening and care into discrete and measurable stages. We will survey existing CC prevention programs in the region to identify their processes, scope and effect. Together with our collaborators and stakeholders we will identify key stages of the Cervical Cancer Prevention and Care Cascade and assess a Cascade in depth, focusing on a sentinel program in Zambia, where we will analyze the full continuum of CC services they provide and identify gaps. An in-depth multifaceted analysis of this program will reveal bottlenecks, facilitators, and barriers to CC care in Zambia. We will synthesize lessons learned and develop a joint agreement on an indicator standard to continually monitor and evaluate Cervical Cancer Prevention and Care Cascades across ART programs in Southern Africa. The Cascade will inform and prioritize evidence-based, resource-appropriate CC screening programs and policy. CC screening should be seen as a continuum of linked step-wise actions that, together, prevent unnecessary deaths from CC. The Cervical Cancer Prevention and Care Cascade will offer a systemic solution to screening and treating CC in low-resource countries and support policy and strategy development, with a focus on sustainability. Our model will incorporate regular monitoring of all stages of the continuum of care, and identify gaps and bottlenecks at national and subnational levels. As we populate the Cascade, we will be better able to see problems with availability and quality of data, and necessary actions to improve health information systems. Addressing gaps in the continuum of care will encourage interventions that improve service delivery and improve health outcomes for HIV-positive women. Policy makers can share knowledge gained from the Cascade, and use this information to set and control targets and accelerate CC screening scale-up. In future, this model could also be applied to efforts in other areas of health care. The 2030 Agenda for Sustainable Development aims to reduce mortality from CC and other non-communicable diseases. To achieve this, we take an integrated multi-sectorial approach to systematically improve CC prevention and treatment over the whole continuum of care, over the long-term. The Cervical Cancer Prevention and Care Cascade will reduce poverty by sustainably developing and improving CC screening programs for HIV-positive women; in turn, this will raise the standard of living for the families of the many women who would otherwise have been stricken with CC.
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