Summary by Erica Asante, MPH Earlier this year, a study titled, “Population-Level Scale-Up of Cervical Cancer Prevention Services in a Low-Resource Setting: Development, Implementation, and Evaluation of the Cervical Cancer Prevention Program in Zambia” was published in the PLOS ONE online journal. The Cervical Cancer Prevention Program in Zambia (CCPPZ), which began in 2006, represents the largest national-level initiative of this kind in sub-Saharan Africa, and serves as a model for the scaling-up of cervical cancer prevention services throughout sub-Saharan Africa and other resource-constrained regions in the world. The Centre for Infectious Disease Research in Zambia (CIDRZ) was tasked to lead the implementation of the initiative with funding from the Zambian Ministry of Health and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Zambia is Pink Ribbon Red Ribbon’s first country of engagement and has been supporting the CCPPZ since 2011. The CCPPZ introduced and scaled-up screening for cervical cancer using the single-visit approach of screening women with visual inspection with acetic acid (VIA) and treating eligible lesions with cryotherapy. Cases of more complex lesions are referred for treatment with loop electrosurgical excision procedure (LEEP), or biopsy in the case of suspected invasive cervical cancer. In this retrospective study of the scale-up of screening and treatment services conducted under the CCPPZ from 2006 to 2013, the authors determined that the following contributed to the success of the program:
- Leveraging the momentum and resources of an ongoing, funded vertical health initiative (HIV care and treatment) to develop capacity for cervical cancer prevention service delivery.
- Adapting cervical cancer screening intervention to the local context instead of rigorously retrofitting approaches that are successful elsewhere.
- Strong investment in the infrastructure for LEEP, coupled with an expanded diagnostic services facilitated the management of complex cervical lesions that exceeded the therapeutic limitations of cryotherapy.
- Continued assessment of all phases of the program by utilizing a rigorous process of monitoring and evaluation of outcomes.
- Strengthening the existing healthcare delivery system on-the-go was an innovative approach to sustainability.
- Providing comprehensive cancer diagnosis and treatment for women with invasive cervical cancer with surgery, radiotherapy and/or chemotherapy at the national cancer center in Lusaka (Cancer Diseases Hospital).