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CERVICAL CANCER PREVENTION PROJECT 2000-2004 Pan American Health Organization Non-communicable Disease Program

Alliance for CervicalCancer Prevention (ACCP): 

Alliance for Cervical Cancer Prevention (ACCP) Members EngenderHealth International Agency for Research on Cancer JHPIEGO Pan American Health Organization Program for Appropriate Technology in Health (PATH) Goals assess screening and treatment methods in low-resource settings improve delivery of services encourage community involvement and ensure community needs considered in programs advocate for increased global awareness of cervical cancer

Alliance for CervicalCancer Prevention (ACCP): 

Alliance for Cervical Cancer Prevention (ACCP) ACCP is working in 28 countries Asia: China, India, Laos, Thailand Africa: Angola, Burkina Faso, Congo Brazzaville, Ghana, Guinea, Kenya, Malawi, Mali, Niger, Nigeria, South Africa, Tanzania Latin America: Bolivia, Chile, Costa Rica, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, Venezuela Caribbean: Jamaica, Suriname, other countries to be determined 22 small grants awarded in 18 countries by PATH Funding provided by the Bill and Melinda Gates Foundation

PAHO’s Overall Goal: 

PAHO’s Overall Goal As part of the Alliance for Cervical Cancer Prevention, PAHO is working with member states to reduce the incidence and mortality from cervical cancer: by identifying, evaluating, and disseminating cost-effective strategies for cervical cancer prevention and control

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PAHO’s Technical Cooperation Program Development to assess needs and evaluate program effectiveness; to offer recommendations on organization of services and quality of cytology laboratories; to strengthen programs Operational Research to evaluate the safety, accessibility, cost and effectiveness of screening and treatment modalities

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PAHO’s Technical Cooperation Quality Improvements in Care to reorient health services to focus on prevention and control of cervical cancer and non-communicable diseases Advocacy and Resource Mobilization to advocate to governments, disseminate scientific evidence and raise awareness of cervical cancer

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Strengthening Programs Caribbean Cervical Cancer Prevention and Control Network needs assessment RedPAC external quality assurance program information system Assessing Screening and Treatment Technologies Peru: TATI demonstration Project El Salvador: VIA demonstration project Chile: HPV prevalence study PAHO’s Project Areas

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Quality of Care and Communications user satisfaction model piloted in El Salvador IEC materials and counseling training piloted in El Salvador Advocacy publications and program documents subregional workshops PAHO’s Project Areas

Needs Assessment: 

Needs Assessment Policy & Management issues financing, organization of services national norms & guidelines leadership, management, evaluation Health Services type and scope of screening and treatment services coverage access to health services cytology laboratories & quality of test results followup care & referral mechanisms Information system for patient management and program evaluation Demographic & epidemiological information

Needs Assessments Conducted : 

Bolivia interviews and visits to health centres, labs and hospitals in 4 departments and conclusions reported to stakeholders led to national and regional plans; strengthening secondary level care; demonstration project on VIA Guatemala assessment findings presented at a national conference led to creation of interinstitutional committee, technical advisory group, pilot project on organized screening and treatment program Paraguay assessment resulted in a national commission, screening and treatment guidelines being developed, demostration project Needs Assessments Conducted

Needs Assessments Conducted : 

Venezuela national program assessment found large variations in organization of services, coverage, quality of laboratories, information management evaluation of the Aragua program shows reduction in mortality Jamaica assessment of the cytology laboratory and information system revealed weak lab management, long delays, no systematic followup of positive Pap smears technical assistance being provided to improve the cytology laboratory performance and management Needs Assessments Conducted

RedPAC program: 

RedPAC program external proficiency testing of 45 cytology laboratories in 7 countries, with Reference Centre in Santiago, Chile cytopathologist evaluation of the performance and management of cytology laboratories Peru, Venezuela, Costa Rica, Bolivia, El Salvador, Jamaica laboratory procedures manual written as a guide to improve cytology laboratory performance future external proficiency testing with digitalized images via internet

Information System: 

Information System Conceptual model developed which describes a modular system with core indicators, functions for patient management and program evaluation and potential outputs such as: screening test result frequency of screening (by age, region, etc.) lists of women with positive test results who need follow-up care type of follow-up care received Prototype is in the developmental stage of pilot testing in El Salvador

Peru: TATI Project: 

Peru: TATI Project Goal: To assess the effectiveness, acceptability and feasibility of incorporating alternative screening and treatment methods into routine primary care services in a low resource setting Highlights from November 2000 - May 2002: About 20,000 women aged 25-49 screened with VIA 3,200 (17%) with VIA positive test results VIA positivity rates ranged: 7% - 30% among the 20 midwives conducting VIA About 2,800 VIA positive women have been screened with VIAM 50% of these women were were detected VIAM positive VIAM positivity rates ranged: 31% - 97% among the 10 doctors using VIAM

El Salvador: VIA demonstration Project: 

El Salvador: VIA demonstration Project Goal: To evaluate the effectiveness of two service delivery approaches in a low resource setting that will screen 20,000 women aged 25-59 over 2 years Service Delivery Approaches: Nueva Concepción: 2 nurses and 2 doctors travel out to 9 health centres to screen women using VIA and VILI and offer immediate cryotherapy treatment Chalatenango: VIA screening is integrated into routine health services in 17 health centres and women who test VIA positive are referred to the regional hospital for colposcopy and treatment

HPV Prevalence Study: Chile: 

HPV Prevalence Study: Chile A study was conducted among 1100 women, aged 15 years and older in Santiago, Chile in order to assess the prevalence of the Human Papillomavirus [HPV] and other risk factors for cervical cancer Recruitment of study participants has been completed Analysis of HPV assays underway

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Quality of Care and Communications Socio-economic barriers Access barriers: accessibility and availability of health centers, ability to pay, acceptance and comfort Lack of interest: screening is a lesser priority than other concerns Discomfort with health professionals, particularly males, conducting gynecologic exam Fear of test results, belief that one cannot cope with cancer diagnosis, either economically or emotionally

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Quality Management and Communications Strategy The quality of service is a management tool directed toward the perceived barrriers and benefits such as: improve the quality of test taking and quality of the sample provide adequate counseling and develop a global communication stategy, focused on the way results are given to patients reduce the amount of time to receive exam results from the laboratory improve the quality of laboratory test results

Piloting the Strategy in El Salvador: 

Piloting the Strategy in El Salvador a user satisfaction baseline survey views and perceptions of 341 women views of 42 health providers in 14 clinics and 2 hospitals results led to areas for improvement of quality of service access to clinics and hospitals turnaround time and quality of test results availability of supplies and materials. planning sessions with health personnel to form working groups and implement quality improvements

Educational Materials and Counseling: 

Educational Materials and Counseling educational materials are being developed and tested for distribution in El Salvador counseling training for 100 health personnel and 200 health promoters provided in El Salvador this pilot experience in El Salvador and the materials will be adapted for use in other countries of the Region

Advocacy and Scientific Dissemination: 

Advocacy and Scientific Dissemination Situational analysis of cervical cancer in Latin America and the Caribbean Literature reviews and synthesis VIA; Cryotherapy; HPV Program Documents Planning Appropriate Programs; Information System Model; RedPAC manual Factsheets Pap test; VIA; natural history; women’s needs Poster, brochure and dossier Women’s stories booklet