Transcript Powerpoint

PEPFAR
An Integrated Mobile Model
Reaching Women in Remote Areas of Zambia by
Building on HIV/AIDS Platforms for Cervical Cancer
Services Delivery
July 24 2014
Top Ten
Cancers
in Zambia
PEPFAR
Treated at Cancer
Diseases Hospital
of Zambia in 2012
Cancer
No.
%
Cervical
632
35
Breast
157
8
Kaposi’s sarcoma
111
6
Prostate
90
5
Oesophagus
51
3
Lymphoma
46
3
Eye
40
2
Colorectal
30
1.6
Keloids
30
1.6
Bladder
29
1.5
Background
• PCI implements comprehensive HIV and AIDS
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capacity building interventions in all 54
Zambia
Defence Force (ZDF) units and surrounding
communities
Funded by PEPFAR through the US Department of
Defense (DOD)
Plus-up funding from the Pink Ribbon Red Ribbon
(PRRR) Initiative
Population of 300,000 – 90% civilians
Most military units are in hard-to-reach and
underserved rural Zambia
ZDF runs a parallel health system with primary
health facilities available in all the units
Program implemented August 2011-April 2014
Facilitating Factors For Rapid Adaptation and
Scale Up
• Existing Ministry of Health cervical cancer screening program using
the “Screen-and-Treat” model with integrated cervicography
• Existing ZDF mobile HIV testing and counseling (HTC) program
• Existing system and tools for HIV behavior change communication
(BCC) programs
• Buy-in from ZDF leadership
Trained nurses and clinical
officers in VIA and
Cryotherapy
Trained Obstetric
Gynecologists in LEEP
Procured equipment and
supplies
Trained drama groups and
peer educators to
implement demand
creation interventions
Why An Integrated Mobile Model with
Integrated Cervicography?
Generalized HIV epidemic and second highest incidence rate of cervical cancer globally
Association between HIV-related immunosuppression and a higher prevalence,
incidence and persistence of HPV and progression to cervical lesions
Sensitivity of VIA with digital cervicography is higher than cervical cytology: 84% Vs
61% (Bateman et al, 2014)
Digital Cervicography: built-in quality assurance system and continuing education
Mobile model: Rural population has poor access to cervical cancer diagnosis,
treatment and prevention services
The Integrated Mobile Model
Self
referrals
ART and MCH
clinics
VIA and
Cryotherapy
Mobile HIV
Counseling
and
Testing
The Integrated Mobile Model Cont’d
Peer educators and drama groups
conduct pre-interventions campaigns
Mobile HIV counseling and testing
provided in tents outside the health
facility
Women are offered cervical cancer
screening services
Cervical cancer screening provided to
consenting women inside the health
facility
Intra-clinic and self referrals accepted
and offered Provider Initiated Testing
and Counseling (PITC)
On-site “Screen and Treat”
Screen: VIA
VIA positive
Offer same-day
cryotherapy
VIA negative
Refer for LEEP/Biopsy
Results: August 2011-April 2014
Women screened
Year
Total
Women
screened
Tested HIV
Positive
VIA Positive
VIA Positive
Treated with
Cryotherapy
VIA
Positive
Referred
for LEEP
n
n
%
n
%
n
%
n
%
2011
580
113
19.4
62
10.7
36
58.0
26
41.9
2012
1663
328
19.7
57
3.4
38
66.6
19
33.3
2013
2709
434
16.0
82
3.0
50
60.9
31
37.8
2014
1614
304
18.8
82
5.0
44
53.6
39
47.5
Total
6566
1179
17.9
283
4.3
168
59.3
115
40.6
Results: August 2011-April 2014
Results: August 2011-April 2014
Lessons Learned
Pre-intervention
demand
creation
activities
really
create demand and clear up
misconceptions about cervical
cancer screening
In settings with generalized
HIV epidemics and high cervical
cancer
incidence
rates,
providing
timely
integrated
screening and HIV testing and
treatment
services
save
women’s lives
Leadership involvement
and
buy-in
result
in
seamless
implementation of programs
Challenges
• Pulling health personnel from an
already over-stretched system to
participate in mobile services
• Referral mechanisms from LEEP
services to diagnostic and treatment
services weak
• Gas not always available and
expensive
References
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CANCER DISEASE HOSPITAL ZAMBIA (2012). Cancer Registry:
Cancer Disease Hospital
CENTRAL STATISTICAL OFFICE ZAMBIA (2010). Census of
Population Report: Central Statistical Office
CENTRAL STATISTICAL OFFICE ZAMBIA (2007). Demographic and
Health Survey: Central Statistical Office
DANGOU, J. (2014, June 18). Cancer and Chronic Respiratory
Diseases, WHO-AFRO. [PowerPoint slides]. Presented at the Africa
Regional Conference on New Opportunities and Innovations in
Cervical Cancer Prevention Lusaka.
GLOBOCAN: Cancer incidence and mortality worldwide database
(2012). Available at: http://globocan.larc.fr (accessed 3rd March
2014)
PARHAM, G. (2014, June 18). VIA and Cryotherapy Accompanied
by Cervicography. [PowerPoint slides]. Presented at the Africa
Regional Conference on New Opportunities and Innovations in
Cervical Cancer Prevention Lusaka.
Acknowledgments
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The American People through PEPFAR funding to the United States
Department of Defence HIV /AIDS Prevention Program’ s (DHAPP)
grant to PCI. Grant Number N00244-14-1-0007
Zambia Defence Force Medical Services (DFMS) Management
including Brigadier General F. Sikazwe, Brigadier General P.
Njobvu, Brigadier General E. Malyangu, Brigadier General A.
Mulela, Lieutenant Colonel F. Malasha and Colonel E.C. Chisoko
The Mobile cervical cancer team including Colonel (Col) S. Banda,
Col. E Banda, Major F. Banda, Major M. Sibindi, Major C. Mukwasa,
M. Ngolwe, and G. Mulenga. We also thank Namwayi Membe for
organizing and collating the data.
The Zambia Ministry of Health and the Ministry of Community
Development Mother and Child Health for providing referral LEEP
services.
Professor Groesbeck Parham and Dr. Sharon Kapambwe from the
African Center of Excellence for Women’s Cancer Control, Center
for Infectious Disease Research in Zambia (CIDRZ)
THANK YOU!