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CGH Roundtable on HPV Screening

, by Lisa Stevens and Isabel Otero

CGH and Partner PRRR meet with representatives of Botswana, Ethiopia, Tanzania, and Zambia.

The NCI Center for Global Health (CGH) extends its congratulations on Pink Ribbon Red Ribbon’s (PRRR) fifth anniversary and continues to build on its three-year partnership. We look forward to participating in PRRR fifth-anniversary-related activities and invite you to follow both @NCIGlobalHealth and PRRR @pinkredribbon to learn more.

On June 22, 2016, the CGH co-hosted a Roundtable on human papillomavirus (HPV) screening in low-resource settings with PRRR a global organization powered by partnerships to fight breast and cervical cancers and improve women’s health. Building on the successes and lessons of the U.S. Emergency Plan for AIDS Relief (PEPFAR) and the ongoing commitment of President George W. Bush and First Lady Laura Bush to reach communities where women are suffering from cancer, PRRR is dedicated to helping women in sub-Saharan Africa and Latin America access preventive care and treatment for women’s cancers. Women with HIV are 4 to 5 times more likely to develop cervical cancer than those who are HIV-negative.

Dr. Lisa Stevens, CGH Deputy Director, moderated the roundtable, which was organized as a side-meeting to the annual Pink Ribbon Red Ribbon Steering Committee (SC) Meeting. The SC meeting took place at the NCI Shady Grove campus in Rockville, Maryland, June 20 and 21.

The roundtable gave scientists at the NCI an opportunity to discuss their work on HPV screening and diagnostics with PRRR SC members, including country representatives from Botswana, Ethiopia, Tanzania, and Zambia. The country representatives are senior members in their countries’ health ministries and are responsible for developing and implementing various aspects of their country’s cervical and breast cancer control programs and policies.

The roundtable started with Dr. Julia Gage from NCI’s Division of Cancer Epidemiology and Genetics presenting on her work to incorporate new technologies into cervical cancer screening programs in low-resource settings. This work includes research on the accuracy and reproducibility of screening and diagnostic tests including automated image recognition via handheld devices and high resolution micro endoscopy. Dr. Gage discussed new models for cervical cancer screening including the use of HPV self-sampling rather than cytology-based programs at the hospital, which has the potential to cut hospital visits by 25% (or more).   She also touched on NCI’s research into the one-dose HPV vaccine, which could transform global cervical cancer prevention in low and middle-income countries (LMICs).  

Dr. Paul Pearlman, program director at CGH, gave an overview of the NCI’s Affordable Cancer Technologies Initiative, which provides grant funding to U.S. researchers to support the development and validation of low-cost, portable technologies with the potential to increase early detection, diagnosis, and non-invasive or minimally invasive treatment of cervical cancer in LMICs. U.S. scientists have the opportunity to work with LMICs scientists as they pilot test and implement their research findings. NCI funding has supported the development, field testing and evaluation of a hand-held, portable and affordable thermo-coagulator to prevent cervical cancer as well as car-battery charged, portable cryotherapy devices.

Celina Shocken, CEO of PRRR, discussed involvement with cervical cancer diagnostics to include two pilot projects the organization is funding in Zambia (with CareHPV) and Botswana (with GeneXpert). She also discussed the policy work PRRR has been doing to include advocating for the World Health Organization (WHO) to update the Comprehensive Cervical Cancer Control Guidelines related to HPV screening.

 The country representatives for Botswana, Ethiopia, Tanzania, and Zambia each presented their country’s priorities for cervical and breast cancer control, including opportunities and challenges for improving research and clinical care in their respective countries. Cervical cancer is the most-common cancer and the leading cause of cancer-related deaths in sub-Saharan Africa region, followed by breast cancer. Cervical cancer screening was recognized as a valuable tool to reducing cervical cancer mortality; however, guidelines on screening among HIV positive women differ from country to country and are especially challenging for low-income countries dealing with weakened health care systems and difficulties regarding follow-up of patients. PRRR works with Botswana, Ethiopia, Tanzania, and Zambia to establish country targets and increase the number of sites offering “See-and-Treat” cryotherapy services. The “See-and-Treat” approach, recommended by the WHO, is an approach in which the treatment decision is based on a screening test, and not on a histologically confirmed diagnosis of CIN2+. Treatment is provided soon or ideally, immediately after a positive screening result.  Challenges discussed included aggressive screening and aggressive follow-up, over-treatment due to a lack of quality control, and loss to follow-up.

Country representatives also emphasized the urgent need to strengthen health care delivery systems and quality assurance. Two out of five women who are diagnosed with cervical cancer are not adequately treated for cervical cancer.

Other organizations represented at the Roundtable included the “Improving Data for Decision-Making in Global Cervical Cancer Programs” (IDCCP), the U.S. Centers for Disease Control and Prevention, the Office of the US Global AIDS Coordinator at the U.S. Department of State, Qiagen, and Merck Vaccines.  

Next steps include exploring establishment of an HPV working group within PRRR to continue these discussions, specifically around the planned HPV screening pilot programs.

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