IAS 2017 IASconference Dr Sharon Kapambwe National Coordinator

#IAS 2017 | @IAS_conference

Dr. Sharon Kapambwe National Coordinator Cancer Prevention Ministry of Health Zambia #IAS 2017 | @IAS_Conference

#IAS 2017 | @IAS_conference Conflict of Interest • No conflicts of interest to declare.

#IAS 2017 | @IAS_conference BACKGROUND • Invasive cervical cancer is one of the commonest malignancies worldwide • Accounts for 22% of estimated new female cancer cases in sub-Saharan Africa • Most common cancer in adult population in Zambia (over 30%)

#IAS 2017 | @IAS_conference HIV and Cervical Cancer • HIV infected women at much higher risk for incidence, progression and persistence of cancer causing HPV infection • Present at younger age with cervical cancer – More rapid progression of chronic persistent HPV infection • Relative immunosuppressive state – Limited to nonexistent cervical cancer

#IAS 2017 | @IAS_conference The Zambian Programme A country of 16 million people Life expectancy 60 years 56% live in rural areas HIV prevalence 13. 3%

#IAS 2017 | @IAS_conference Zambian Context-2003 • Physician patient ratio: 0. 12/1, 000 • Raging HIV epidemic (HIV Prevalence 16. 5%) • Increasing cervical cancer cases – No chemo-radiation treatment centre – Limited cytology based screening doctor led – No HPV vaccination • • 25 gynecologists in the nation 6 pathologists in the public sector No cytologists Competing priorities

#IAS 2017 | @IAS_conference Gynecol Oncol 2006; 103: 1017 -22.

#IAS 2017 | @IAS_conference Local solutions • Visual Inspection with Acetic – • • • (available, low-cost, same-visit, and optimally accurate) – Inadequate laboratory infrastructure to support cytology basedscreening Treatment of pre-cancer that is setting-appropriate , lower cost, and relatively easily implemented – Cryotherapy- Challenges encountered – Thermal coagulation offers better alternative Local training program for nurses and doctors in VIA, Cryotherapy and LEEP Introduction of innovation: “electronic cervical cancer control” —e. C 3 – Point of care data electronic data collection – Distance consultation – Monitoring and evaluation – Continuing medical education

#IAS 2017 | @IAS_conference Program Implementation 2006 • Integrated into two governmentoperated public health clinics • Nurse led, VIA based, “Screen and Treat” platforms • Government and PEPFAR/CDCsupported • • Target HIV-infected women – Open to women with HIV uninfected and unknown status – HIV testing offered

#IAS 2017 | @IAS_conference Three-Phase National Scale-Up with government ownership 1 Provincial hospitals 2 District hospitals 3 - Nursing schools, functioning theatre - VIA, Cryotherapy, LEEP - VIA, Cryotherapy +/- LEEP Health facilities - VIA, Cryotherapy

#IAS 2017 | @IAS_conference 2006

Cervical Cancer Screening Clinics in Zambia (2017) Nchelenge Chienge Kaputa Mporokoso. Mpulungu Mbala Kawambwa Nakonde Mungwi Isoka Kasama Luwingu Mwense Chinsali Chilubi Chama Mansa Samfya Mpika Mwinilunga Milenge 1 Lundazi Solwezi 3 2 4 5 Lufwanyama 6 7 vuma Zambezi alabo Kabompo Serenje Masaiti Mufumbwe Mambwe Mpongwe Kasempa Mkushi Kapiri Mposhi Lukulu Chipata Petauke Katete Chadiza Nyimba Kabwe Urban Kabwe Kaoma Mumbwa Chibombo Mongu Chongwe Lusaka (12) Luangwa Kafue Itezi-Tezhi Senanga Mazabuka Namwala Monze hangombo Siavonga Choma Sesheke Gwembe Key: 1. Chililabombwe 3. Chingola 4. Kalulushi #IAS 2017 | @IAS_conference Kalomo Kazungula Livingstone Sinazongwe VIA only 2. Mufulira 5. Kitwe 6. Ndola Urban 7. Luanshya LEEP and VIA

#IAS 2017 | @IAS_conference Achievements • Cervical cancer screening part of HIV treatment guidelines, HIV linkages in National Cancer Control Strategic Plan – Linkages with HIV care and treatment clinics • Close to 370, 000 women screened, 29% HIV infected • HPV vaccination demonstration done, national scale planned • Establishment of chemoradiation centre with in patient facilities • Increased number of partners

#IAS 2017 | @IAS_conference Challenges • Funding limited for cervical cancer • Still not “mandatory” for women living with HIV to get screened for cervical cancer • Integration needed between cervical cancer screening and HIV • HPV vaccination for adolescent and screening needed

#IAS 2017 | @IAS_conference Recommendations • Make cervical cancer screening part of HIV care • Strategies needed for adolescents living with HIV to be vaccinated and screened – Research on HPV infection in adolescents needed • Increased funding base for cervical cancer screening

#IAS 2017 | @IAS_conference Acknowledgements • Ministry of Health, Zambia • Centre for Infectious Disease Research in Zambia • Co-operating partners • The nurses, doctors and all support staff working in screening centres around the country • The International AIDS Society for this session • Women of Zambia for advocating and accepting this programme