Integrating Cervical Cancer Prevention Services into the Care and Treatment of Women Living with HIV/AIDS in Cote

dIvoire
Date : 05/10/2013 Presenter Name : Oumar Toure Country Office : Cote DIvoire Presenter Title : Technical Advisor on CECAP

Outline
Background Cervical Cancer Prevention Project Key Implementation Steps Key Achievements Challenges Lessons Learned Success Stories

Background
Cte dIvoire: West Africa Population: 20 millions inhabitants Highest HIV prevalence in West Africa: 3.4 Cervical cancer is the leading cause of mortality due to cancer among women HPV prevalence in West Africa is higher 21,5 versus worldwide 10
1. 2. 3. 4. Institut National de Statistique _ 2006 EDS_2012 Programme National de Lutte contre le Cancer _ 2012 (WHO-AFR/RC60/6-2010)

Cervical Cancer Prevention Project

Five year CDC/PEPFAR funded project (2009-2014) Goal: To help reduce cervical cancer morbidity and mortality in WLHIV. Specific objectives: 1. To orient stakeholders for the development and implementation of national strategies and programs for cervical cancer prevention 2. To integrate cervical cancer screening as a systematic service to offer as part of care and treatment of Women Living with HIV 3. To initiate mass awareness about cervical cancer burden
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Key Implementation steps

Advocacy meeting with stakeholders Establishment of a high level technical advisory and technical working group Rapid situation analysis Procurement of equipment and supplies Trainings Supportive supervision visits to health facilities

Key Achievements
20 pilot sites were upgraded in 19 health districts to provide VIA/cryo 8925 HIV+ representing 72% of female cohort aged 17 to 50 receiving HIV care and treatment within 20 pilot sites received at least once IVA 9% HIV+ women presented VIA positive among which 76% received Cryo according to SVA 4522 HIV neg. also received the VIA at the same time among which 3% were VIA+ 40% of women screening VIA+ presented large lesions not eligible for cryotherapy

Key Achievements cont.

Chart A : Number of new VIA screenings conducted
HIV ngative 4522 ( 34%)

Chart B : Percent of VIA positive by HIV status

9% 8% 7% 6% Percent 5% 4% 3% 2% 1% 3% 9%

HIV positive, 8925, (66%)

0%

HIV positive
HIV Status

HIV ngative

Key Achievements cont.

Chart C: Percent referrals for large lesions Chart D : # SVA RATE HIV + # of new clients with VIA+ receiving immediate cryotherapy # of new clients with VIA today AND cryotherapy postponed

45% 40% 35% 30% Percent 25% 20% 15% 10% 5% 0%

24%

40% 25%

HIV positive HIV ngative HIV status

76%

Challenges
Constant transfer out of health care provider Existing clients circuit in the hospital Lack of motivation of provider in general Maintenance/repair of Cryotherapy machines The lack of privacy about the HIV status in the facilities Insufficient of referral sites for LEEP (2 for 20 sites dispersed widely in the country) Insufficient capacity of laboratories specimen analysis post surgery after LEEP

Lessons Learned
Importance of Working closely with PLHIV; Match VIA screening Schedule with any other; Raise awareness of all healthcare providers at any station/ward of the facility; Include a section on CECAP in the patient file Match the screening day with the market day
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Success Stories
Happy and delivered I feel said Mrs. K.A., an HIV positive woman after she was told to be VIA negative in her one year follow up rendezvous. MOH has decided to scale up cervical cancer screening with VIA nationwide for the coming five years Other donors (UNFPA) awards CECAP through VIA/Cryotherapy in CDI regardless to HIV status Cervical cancer screening with VIA is mentioned as a must in the national guideline for HIV/AIDS care and treatment

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Successful integration of cervical cancer prevention in HIV/AIDS care and treatment leads to smile recovery

MERCI BEAUCOUP

Toure.oumar@jhpiego.org

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