April 29, 2022
Cervical cancer is preventable, yet it remains the second most common cancer and the leading cause of cancer death in Kenyan women. Women living with HIV (WLWH) are at a much higher risk of developing cervical cancer, which progresses much faster in HIV-positive people due to their compromised immune status. Despite this risk, WLWH have much lower screening rates for cervical cancer than women without HIV.
CIHEB-Kenya has sought to address the gap in access to this critical service in Nairobi County through its recently ended Partnership for Advanced Care and Treatment (PACT) Endeleza program funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the Center for Disease Control and Prevention (CDC). The program’s work now continues in the newly awarded County Ownership and Networks to maintain Nairobi epidemic control (CONNECT) program. CONNECT works with the Ministry of Health, the National Cancer Control Program (NCCP), and the Nairobi Metropolitan Service (NMS) to fast-track progress towards the UNAIDS 95-95-95 targets of HIV epidemic control and to reduce HIV incidence and AIDS-related mortality as articulated in the Kenya AIDS Strategic Framework II.
New Treatment Methods
Lesions are an abnormality in the cells of the cervix that could eventually develop into cervical cancer. These lesions, when detected early, can be managed appropriately preventing their advancement to cancer.
CONNECT program has introduced a new treatment using thermal ablation, a procedure that uses heat to destroy the abnormal tissue or destroy its function. This is easy and simple to use as an alternative to cryotherapy, the use of extreme cold to freeze and remove abnormal tissue, previously used. Cryotherapy has much higher maintenance costs, such as procuring and storing the liquid nitrogen needed or the cryochamber; thermal ablation only requires electricity to charge the handheld devices before use on multiple clients.
While cryotherapy and thermal ablation can clear lesions by up to 95%, thermal ablation can be done in lower-level facilities, unlike cryotherapy, which had to be done at Level 4 or 5 hospitals. Thermal ablation has enabled the use of a single visit approach where a woman is screened and treated on site if positive.
Bridging the Knowledge Gap
CIHEB-Kenya’s CONNECT program supports 65 facilities in Nairobi, all of which offer comprehensive HIV testing, prevention, and treatment service. 51 offer prevention of perinatal HIV transmission services, 13 are drop-in clinics for male and female sex workers, and two are drop-in clinics for people who inject drugs. To support rapid scale-up of cervical cancer screening for WLHIV the program identified gaps that it sought to rectify through training.
The program conducted a five-day training, equipping healthcare providers with skills to conduct cervical cancer screening and management of precancerous lesions. The training involved three days of theory followed by two days of practicum.
“The training was focused on equipping healthcare providers with skills to manage women with lesions using ablation and cryotherapy,” said Robert Rianga, Head of the Cancer and Palliative Unit in NMS.
Clients who require advanced care are referred to hospitals such as Mbagathi District Hospital and Kenyatta National Hospital (KNH) for tertiary care.
“The plan is to reach as many healthcare workers as possible, ensuring that they can screen all eligible women for cervical cancer and treat the lesions appropriately.” explained Ms. Rose Nyaboke, Reproductive Health Lead for the CONNECT program. “Where necessary, those who need referral for further management are referred to tertiary facilities. The healthcare providers are also able to administer the HPV vaccine for girls aged 9-14 years, and HPV self-testing for women aged 30 and above as recommended by the Kenya National Guidelines.”
Challenges and Way Forward
Women found to have advanced lesion need to be treated at a higher-level facility for management including Loop Electrosurgical Excision Procedure (LEEP). This requires specialized equipment, which are not available in lower lever health facilities.
“Many women who are referred to tertiary facilities do not go there as these services attract a fee that these women are not able to afford,” said Ms. Nyaboke. “By the time these women come back to the clinic, the cervical cancer has progressed to an advanced stage. This has resulted in increasing mortalities related to cervical cancer.”
By working with the NMS, as well as with the NCCP, CONNECT is playing a crucial part in ensuring that all private and public health facilities provide routine screening, timely management of suspicious lesions and treatment for cervical cancer for all women.
Contact
Center for International Health, Education, and Biosecurity
Institute of Human Virology
Tyler New
Scientific Writer
tnew@ihv.umaryland.edu
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