Botswana

Cervical cancer is the most common cancer and leading cause of cancer-related deaths among women in Botswana (29 percent of all newly developed cancers in women in 2012).

Breast cancer is the second most common cancer among women in the country (18 percent of all newly developed cancers in women in 2012).

Country targets supported by Pink Ribbon Red Ribbon:

  • Screen 80 percent of women aged 30-49 years for cervical cancer at least once.
  • Vaccinate at least 80 percent coverage of girls within the target population against the human papillomavirus (HPV).
  • Scale up “Screen-and-Treat” services to new sites during 2017.
  • Explore HPV molecular testing as a demonstration program.

Please view our road map for more information about our programs in Botswana. 

Botswana Road Map

 

Click here to view a detailed map of PRRR sites in the country. 

HISTORY 

Nurse Alexandra Seiphetiheng talks to women about the cervical cancer screening process at the Bontleng Health Clinic in Gaborone

The Government of Botswana welcomed Pink Ribbon Red Ribbon in 2012, the same year the Ministry of Health unveiled a five-year national strategic plan for cervical cancer prevention and control. The plan endorsed visual inspection with acetic acid (VIA) and cryotherapy to complement cytology (Pap smears), and included a proposal to introduce HPV vaccinations to the country in 2017. Following advocacy and technical support by Pink Ribbon Red Ribbon, and with funding and supplies donated by Merck, the World Bank, and Becton, Dickinson and Company (BD), the Government successfully implemented a two-year HPV vaccination demonstration program from 2013-2014, a full two years ahead of schedule, achieving a coverage rate of 91 percent of the targeted population of girls aged 9 to 13 years.

Based on the success of the demonstration program, the Government of Botswana introduced and fully funded a nationwide HPV vaccine campaign in 2015. Supported by Pink Ribbon Red Ribbon, the Government adopted a two-dose regimen. Administration of the first dose took place between February and March 2015, and the second dose between September and December 2015. The campaign reached 62,817 of the 69,852 targeted girls between the ages of 9 and 13, for a coverage rate of 90 percent. The second year of the nationwide roll-out began in February 2016. Botswana has since incorporated HPV vaccination into the country’s Expanded Program on Immunization, and now will vaccinate a cohort of girls every year.

The Government of Botswana, through the Ministry of Health, committed in 2013 to supporting “Screen-and-Treat” sites as part of its long-term plan to implement these services in all health districts. In partnership with Pink Ribbon Red Ribbon, the World Bank made a contribution that supported the scale-up of healthcare provider training; paid for the procurement of equipment for screening and treatment facilities; and enhanced infrastructure for information technology, HPV-vaccination programs, and histology capacity. This has allowed for more HIV-positive women to receive timely screening and treatment for cervical cancer.

In 2013, through the University of Pennsylvania-Botswana Partnership, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supported the scale-up of cervical-cancer programs to additional facilities, the training of more than 50 healthcare providers in “Screen-and-Treat,” and the procurement of equipment. The Botswana Country Office of the Joint United Nations Programme on HIV/AIDS (UNAIDS) also contributed to the training of health workers in “Screen-and-Treat” by paying for a capacity-building conference. The American Society for Clinical Pathology advised the Ministry of Health on solutions for improved and technologically-enhanced diagnoses, beginning with efforts to improve histology capacity. They also sent a team to Botswana to help clear a backlog of over 3,000 unprocessed Pap smears to get women their results.

ACHIEVEMENTS 

A consortium led by the National Foundation for the Centers for Disease Control and Prevention (CDC Foundation), entitled “Improving Data for Decision-Making in Global Cervical Cancer Programs” (IDCCP) assessed the existing system to monitor and evaluate the national program to prevent and control cervical cancer, as part of a process to develop global standards, tools, and guidance to enhance the quality, coverage, and scale of interventions against the disease, and recommendations from the assessment are currently being implemented.

UNAIDS developed educational (IEC) materials on cervical cancer in English and Setswana, and disseminated them widely to “Screen-and-Treat” sites, while supporting the efforts of local community-based organizations to create demand and improve the understanding of cervical cancer at the community level.

The U.S. National Cancer Institute (HHS/NIH/NCI) and Jhpiego conducted a mid-term review of the National Cervical Cancer Prevention Programme’s Five-Year Comprehensive Prevention and Control Strategy (2012-2016), which included assessments of the clinical skills of nurses, and will influence the selection of the new sites and improve the quality of screening and treatment.

In 2015, the Government of Botswana announced VIA as a recognized standard for cervical cancer screening, and is committed to ensuring the service is available across the country. Looking ahead, Pink Ribbon Red Ribbon is supporting Botswana in its plans to explore an HPV diagnostic testing program, and to expand the current “Screen-and-Treat” program to new sites and greater coverage levels.

Progress of PRRR Collaboration in Botswana (July 2012 – December 2016)

  • Girls vaccinated against HPV:
    • Demonstration project
      • 2013: 2,015 (Doses 1-3)
      • 2014: 6,376 (Doses 1-3)
    • Nation-wide 2-dose campaign
      • 2015: 62,817 (Dose 1 and 2 completed)
      • 2016: 22,809 (Dose 1 completed)
  • Sites that currently offer cervical cancer screening and treatment: 20
    • VIA and cryotherapy: 20
    • Loop Electrosurgical Excision Procedure (LEEP): 9
  • Health staff trained in “See- and-Treat”: 101
  • Health staff trained in LEEP: 18
  • Master trainers for community outreach (“See- and-Treat”): 21
  • Women Screened with VIA: 22,933
    • Of Women Screened, Number VIA-Positive: 5,868
      • Of Women VIA-Positive, Number Treated with Cryotherapy or LEEP: 5,660

Contributions from Pink Ribbon Red Ribbon Partners

  • U.S. Government: US$ 3 million through the President’s Emergency Plan for AIDS Relief (PEPFAR) to scale-up “See-and-Treat,” train health care providers and procure outpatient screening and treatment equipment, including US$ 1 million to Jhpiego to refresh the training of providers at existing sites and open new ones; HHS/NIH/NCI $50,000 in-kind support to mid-term review of national cervical-cancer prevention plan.
  • World Bank: US$ 385,000 for logistics of HPV vaccination; scale-up of “See-and-Treat” in four Districts, including mobile units in two; purchase of automated histology equipment; and improved data management.
  • The American Society for Clinical Pathology: US $100,000 contribution to a consultancy to improve histology capacity.
  • Airborne Lifeline: Over US$ 50,000 worth of transportation of healthcare providers and equipment.
  • UNAIDS: US$ 36,000 to co-fund activities with the MoH implemented with support from District Health Management Teams and Tebelopele to improve literacy at the community level about the prevention and treatment of cervical cancer, by training master trainers, community-based organizations and health facility officers, and by developing IEC materials in English and Setswana on cervical cancer and HIV. 
  • American Society for Colposcopy and Cervical Pathology: Training on colposcopy.
  • Merck: Donation of 9,840 doses of quadrivalent GARDASIL® HPV vaccine in 2013, and 46,000 doses in 2014.
  • BD/Medisend: Donation of 100,000 auto-destruct SoloShot® syringes for HPV vaccination through CMMB worth US $10,000.
  • Bill and Melinda Gates Foundation/CDC Foundation/Indiana University: Baseline analysis of data system for cervical cancer under IDCCP project.

Dr. Naa-Anyeley Ntsima performs LEEP surgery on a client in Nyangabgwe referal hospital in Francistown

2017 Pink Ribbon Red Ribbon Priorities

  1. Make functional six additional screen-and-treat sites and standardization of service delivery across all sites;
  2. Launch a demonstration program for HPV molecular testing, leading to the inclusion and implementation of HPV testing in the national strategy;
  3. Ensure the continued success of the nationwide roll-out of HPV vaccination throughout 2017 (as measured by an enrollment level for the second dose above 90 percent);
  4. Identify new global financing opportunities to sustain the cervical cancer program; and
  5. Promote further integration of cervical cancer screening in HIV-funded programs.