The 2017 AORTIC International Conference on Cancer convened from November 7-10 in Kigali, Rwanda. The AORTIC Conference is a platform dedicated to collaboration and learning, and each conference brings together multidisciplinary specialists from all over the global cancer community. The goal of the conference is to work to reduce the impact of cancer in Africa. At this year’s conference, several PRRR partners presented on our collaborative work to decrease the cancer burden in Sub-Saharan Africa.
Jhpiego presented a poster titled “Engaging Private Sector to Strengthen System for Maintenance of Cryotherapy Machines: Lessons from Tanzania.” Tanzania has one of the highest cervical cancer rates in East Africa; in fact, cervical cancer is the leading cause of cancer deaths in Tanzanian women. In response, PRRR has worked in Tanzania since 2014 with many partners, including Jhpiego, who implements PEPFAR-funded programs with national and regional-level support. The Ministry of Health, Community Development, Gender and Children in Tanzania works with PRRR and USG funded implementing partners such as Jhpiego to support the scaling up and strengthening of cervical cancer prevention, screening, and treatment services in almost 460 sites. Specifically, Jhpiego has worked with the Ministry of Health to support regional and national-level activities, including strengthening health care system blocks through guidelines development, service delivery, QI, training, and maintenance of cryotherapy machines. Cryotherapy is widely used in Tanzania – at almost 400 sites – to treat cervical precancer lesions. However, the frequent breakdown of cryotherapy machines has become a critical roadblock when screening women. Jhpiego has been able to facilitate supportive supervision to strengthen the skills of technicians and providers in maintenance and troubleshooting. Their efforts in training and capacity building have minimized the breakdown of cryotherapy machines and increased technicians’ maintenance skills.
Susan G. Komen presented a poster titled “Promising Practices for Equitable Access to Oncology Care in Zambia” to illustrate how civil society efforts can support a strategy for reducing breast cancer mortality. The team discussed promising practices that responded to the gaps identified in an analysis of the status of breast and cervical cancer control services in Zambia conducted in 2015. All practices implemented evidence-based initiatives to address the health care system deficiencies with view to integrating breast cancer on cervical cancer activities.
Examples of evidence-based programs that provide the opportunity to improve services and lay the foundation for the eventual expansion of women’s cancer control activities in Zambia included trainings for local health professionals on breast health skills; and the African Breast Cancer Disparities in Outcomes research study – a study of breast cancer survival in sub-Saharan Africa conducted in collaboration with IARC. The Churches Health Association of Zambia coordinated mobilization activities in the Lusaka district with the Ministry of Health in which 118,000 individuals from 19 sub-districts in Lusaka were trained to educate low-income communities, over 46,000 people engaged in outreach (through door-to-door advertising, speaking at churches, and working with the media), and over 55,000 girls aged 9-11 attended vaccination events.
More recently, Susan G. Komen hosted the Zambia Breast Cancer Co-Creation Lab, a consultative meeting to discuss solutions to diagnose breast cancer earlier. The Zambian Ministry of Health, Cancer Diseases Hospital, representatives from Susan G. Komen, and other PRRR partners participated in a design thinking exercise to highlight resources, gaps, and next steps in building a national breast cancer response.
Breast and cervical cancers are the most common malignancies in Zambia, accounting for almost half of all cancer related deaths in the country. For this reason, when PRRR was launched in 2011, Zambia was chosen as our first partner country. Zambia was also the first country in which Susan G. Komen and PRRR were able to leverage existing platforms for cervical cancer and HIV/AIDS to promote improved breast cancer control.
CUAMM presented a poster titled “Using Smartphones and Imaging of an Enhanced Visual-Assessment Device to Detect Cervical Cancer in Low-Resource Settings: A Pilot Program in the Federal Democratic Republic of Ethiopia.” In Ethiopia, cervical cancer is the second-most prevalent cancer among women, accounting for 13.4% of all cancer cases. The primary screening method for cervical pre-cancer in Ethiopia is VIA (visual inspection with acetic acid). Since the accuracy of VIA depends on the provider’s ability to properly visualize the cervix, the process can be improved with technology. The MobileODT Enhanced Visual Assessment (EVA) is a portable colposcope that improves diagnostic accuracy during visual inspection. Its magnifying lens and flashlight reduce the subjectivity of a VIA test. A built-in app enhances clinical supervision by transmitting documentation of the patient’s lesions in real-time. With funding from the American Cancer Society through PRRR, CUAMM piloted a study to assess how ready and capable the MobileODT system is for large-scale, national uptake.
During the study, 2068 women were screened at 11 sites: Eight facilities in the Oromia region of Ethiopia acted as intervention sites, and three were control sites. Half of the women were screened with MobileODT, and the other half were tested with normal VIA, which did not include the MobileODT technology. In the intervention group, the VIA-positivity rate was 6.3% at baseline and 6% at end line. When data from women screened via MobileODT EVA were analyzed, the difference in terms of number of positive cases detected between the intervention and non-intervention group increased (7.7% vs 3.8%). In conclusion, the study found that MobileODT could improve diagnostic accuracy. Qualitatively, researchers observed that more effort can be made to increase the commitment of health workers to use MobileODT due to a lack of understanding of the technology and cultural barriers.
PRRR works in collaboration with other funders, implementing partners, and other stakeholders to decrease the cancer burden in Sub-Saharan Africa. These three posters highlight the great work our partners have done in service delivery, program design, and research, and we at Pink Ribbon Red Ribbon are thrilled to see our partners promoting the work enabled by our partnership model.