Duration: 2022-2025
Cervical cancer is the 1st most common cancer and the leading cause of cancer death among women in eSwatini (341 new diagnoses and 214 deaths estimated every year. With an estimated incidence rate of 84.5 per 100,000 female population (world rate: 13.3, and an estimated mortality rate of 55.7 per 100,000 female population (world rate: 7.25), eSwatini has the highest cervical cancer incidence and mortality rates worldwide.
A screening program for cervical cancer was introduced by the Ministry of Health in 2009, with an integration of visual inspection with acetic acid (VIA) and/or cytology with surgical procedures such as cryotherapy and ring electrosurgical excision (LEEP) through a “screen and treat” approach. However, access to the services has been limited, because of sociocultural reluctance, and lack of awareness about the disease and are poorly informed on screening procedures for cervical cancer, especially among women living in rural areas. The data from the ministerial program highlighted how, in 2015, a total of only 20,009 women (out of an estimated population of 291,038 women in reproductive health) were screened with 16,496 (82.4%) showing abnormal results.
Regarding screening, compared to cytological examination or direct inspection, which aim at the early identification of lesions, HPV-DNA detection and its genotyping allow to identify early a condition predisposing the disease, also guaranteeing larger time frames in contexts where adherence to screening and follow-up is limited.
The HPV-test on a fresh urine sample or DUS represents a safe and highly sensitive method, which offers the unquestionable advantage of non-invasiveness and the possibility of reaching a high adherence rate also among vulnerable populations belonging to the youngest age groups.
Project Leader
- University of Milan
Partners
- University of Milan
- Cabrini Ministries
- Cepheid
Funding
- Missionary Sisters of the Sacred Heart of Jesus (MSC)
- Cabrini Outreach
- Cepheid
Goal
To strengthen women’s health in eSwatini.
Objectives
- To provide a comprehensive screening and prevention package for HPV infection and cervical cancer to all women 12-49 years of age who seek care at the St. Philip’s clinic and, in a second time, to all women living in the catchment area of St. Philip’s.
Activities
- Assessing the introduction of the fresh urine and the DUS tests in a rural clinic, its feasibility and effectiveness;
- Assessing the system of recovering persons who have been tested to provide results and the necessary care, including referral to secondary facilities;
- Assessing the cost-effectiveness and cost-benefit of the intervention compared to current practice or no intervention to inform and contribute to policy change in the country;
- Assessing the acceptability of the use of non-invasive test rather than invasive ones;
- Assessing the effectiveness of introduction of anti-HPV vaccination in young girls (9-14 years) if and when available;
- Assessing the extension of screening to the female population that does not come to the local health care network or would still not be screened due to their young age.
Impact
- Increase the acceptability of HPV test and therefore the attractiveness and adherence to screening in adult women
- Include in the screening that part of the population (pre-adolescents and adolescents) in which the VIA, because of invasiveness, may not be the test indicated in the first instance