Global Health and Diplomacy (GHD) Fall 2016 Issue: The Global Impact of Antimicrobial Resistance :: Deborah L. Birx, M.D. and Celina Schocken J.D., M.B.A., M.P.P. , Pink Ribbon Red Ribbon CEO
Full article here.
Cervical cancer is an almost entirely preventable disease that continues to claim the lives of 260,000 women every year.1 Virtually all cases of cervical cancer are caused by the Human Papillomavirus (HPV), the most common sexually transmitted disease in the world.2-4 Pink Ribbon Red Ribbon is an innovative public-private partnership working to raise awareness and increase access to lifesaving prevention and treatment of women’s cancers.
We have cost effective tools in the arsenal to prevent and treat cervical cancer. HPV infection can be prevented through vaccines, protecting against up to 90 percent of cervical cancers.5,6 The HPV vaccine also protects against HPV driven cancers in men. Currently in resource limited settings, screening for cervical precancer is performed using Visual Inspection with Acetic Acid (VIA), the cervix is coated with vinegar, causing lesions to appear white in color. For treatment, the current method is ablation of the lesion using cryotherapy. VIA and cryotherapy are viable options in most low-resource settings.7
Armed with highly effective vaccines against HPV and low-cost methods for screening and treatment of precancerous lesions, a cervical cancer-free generation of women is finally within reach. While the technical capacity exists to ensure that no woman dies of this preventable disease, in reality we are far from achieving this goal.
In 2013 alone, there were over half a million new cases of cervical cancer worldwide, with 87 percent of cervical cancer deaths occurring in resource limited settings.1,8 Much of the burden is concentrated in Sub-Saharan Africa, where it is the most common cancer death among women.9-11 Cervical cancer incidence and mortality rates in the region are the highest in the world,12 due to the limited access to screening and treatment programs and the aggressive nature of the disease in HIV positive women.
Implementation of the core interventions along the continuum of care, starting with preventing HPV infection through vaccination is critical, followed by the early detection and treatment of precancers before they develop into advanced disease. Cervical cancer continues to take its devastating toll on women around the world. Innovative technologies, partnerships and programming can change the current narrative and set us on a different trajectory.
OPPORTUNITIES FOR INNOVATION
1. Technological Innovation
Several groups have developed, and are developing, lower-cost alternatives to the traditional colposcope for visualization of the cervix. Called digital cervicography, these devices hold the promise of improving the quality of visual inspection, to ensure accurate diagnoses. They allow the health worker to see the cervix more clearly, and also take a photo so that supervisors can see the image as well. A bright light source and powerful magnification lens allow for enhanced visualization capabilities. Visualization imaging technologies, in combination with VIA and HPV diagnostics, are improving our ability to detect and subsequently treat cervical precancer.
HPV Diagnostic Testing
One of the best options for accurately diagnosing cervical precancer is an HPV diagnostic test, which determines whether the virus is present. HPV diagnostic tests have been available for several years and are frequently used in high-resource settings. Two companies have submitted diagnostic tests developed for use in low-resource settings to the WHO for pre-qualification, and several other companies anticipate marketing tests designed for low-resource settings soon.
One advantage of HPV diagnostic testing is the possibility of allowing women to collect their own cervical samples, which reduces the burden on health workers, and is preferred by most women.
2. Innovative Partnerships
Pink Ribbon Red Ribbon® (PRRR) is a global public-private partnership that leads coordinated action to save lives from women’s cancers in countries where the need is greatest. Building on the success of PEPFAR and the comprehensive prevention and treatment platform for HIV, PRRR was launched in September 2011 by the George W. Bush Institute, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G. Komen® and the Joint United Nations Programme on HIV/AIDS (UNAIDS). PRRR has since grown to over 20 partners. This year marks the fifth anniversary of the partnership.
The founding of PRRR reflects the United States’ focus on insuring women thrive so communities and countries thrive. Women with HIV are particularly vulnerable to cervical cancer, and PRRR is committed to making sure that women who survive HIV through access to lifesaving treatment through PEPFAR do not succumb to this preventable and treatable disease.
PRRR has proven in the first five years to not only be an innovative model in global women’s health but an effective approach, building on the success and health system supported by PEPFAR, it addresses another prevalent disease to maximize the impact on both. PRRR facilitates multi-sectorial action and coordination, and the diversity of our partnerships allows us to intervene at every step of the cervical cancer continuum of care.
PRRR programs operate in alignment with national cancer plans and targets, with the overarching goal of strengthening countries’ capacities to deliver cancer control through sustainable programs that are country led, financed and managed. PRRR responds to national needs and priorities by filling crucial gaps to ensure comprehensive service delivery.
PRRR’s partnership model promotes collective ownership and accountability, reduces coordination demands on the part of partner countries, and provides opportunities to build on existing work. By emphasizing synergy, PRRR’s model avoids creating redundancies in parallel programming among partners with overlapping goals, and is able to maximize impact.
Since the partnership’s inception, PRRR and our partners have vaccinated over 120,000 girls against HPV, screened over 315,000 women for cervical cancer, and provided treatment to over 22,000 women. PRRR’s achievements in its first five years of existence are a testament to the advantages and strengths of this innovative and continually expanding partnership model.
3. Innovative Programming
The United Republic of Tanzania has only one hospital that provides specialty cancer care. Based in Dar es Salaam, Ocean Road Cancer Institute (ORCI) treats close to 10,000 women each year for cervical and breast cancers, 60 percent of whom live outside the capital. Most women with advanced cancer do not seek care, or cease treatments shortly after initiation, because they live too far from the hospital and lack a safe and affordable place to stay between treatment sessions. Women who lack access to long-term lodging close to the treatment center face the prospect of having to camp outside without shelter.
To combat this issue, PRRR, the American Cancer Society, the George W. Bush Institute, HKS, Inc., Southern Methodist University, and T-MARC Tanzania launched Hostels for Hope, an international architecture and design competition. The winning designs will be used to construct “home-away-from-home” communities for cancer patients receiving treatment at ORCI. Exciting and innovative designs were received from nearly every continent of the world, and are currently under evaluation by an international panel of architects.
Hostels for Hope is an example of truly innovative, cross-sector programming that provides an opportunity to advance the goals of socially responsible architecture, while breaking down a critical barrier to cancer treatment for women in Tanzania.
Cervical cancer is a preventable, treatable disease, significantly impacting women and their families in low resource settings. Without significant investment and unprecedented levels of cooperation among government, public- and private-sector stakeholders, the global cervical cancer burden will continue to grow. Deaths from cervical cancer are projected to double by the year 2030, and the mortality burden will fall almost entirely on women in low-resource settings.13 Innovative technologies, partnerships and programming can increase the accessibility and affordability of cervical cancer preventive services, fill crucial gaps in service delivery, and improve patient outcomes, ultimately saving hundreds of thousands of lives. By investing in innovative approaches for the prevention of cervical cancer, we invest in women, who strengthen families, communities and nations, and drive global economic growth and prosperity.