A Commitment To Eliminate Cervical Cancer In Africa For FIND

April 07, 2023

By Jessica Ahedor [caption id="attachment_105647" align="alignnone" width="1023"] Dr Angela Muriuki[/caption] Nairobi, Kenya- Dr Angela Muriuki, Director of Women’s Health at FIND, says Sub-Saharan Africa requires strong political commitment and resolve to eradicate cervical cancer as a public health issue that affects not only individuals but also households, communities, nations, and regions. Fielding questions from Pan African Visions, Dr Muriuki says galvanizing action towards elimination requires strong government leadership with the political willingness, commitment and resource investment to ensure that cervical cancer is no longer a public health problem. “Countries in the region can do that through understanding the targets set by the World Health Organization as markers of progress towards elimination of this disease as a public health problem and find out whether progress is being made in your household, community, country and region,” Dr. Muriuki explained. Can you provide a brief background about FIND and what it does as a programme. Dr Angela Muriuki: FIND is a global non-profit focused on the development and access of quality diagnostic testing. We are working to ensure that everyone who needs a test can get one – so that people can be linked to care as soon as possible, and lives can be saved. The COVID-19 pandemic showed how fundamental diagnostics are to sustainable, resilient health systems, providing critical data for decision-makers and picking up outbreaks of new or existing diseases. Women’s Health is a newly constituted programme within FIND. Our main goal is to drive attention, partnership and action to meet the critical gap in diagnostics for conditions that affect women and girls, based on their unique requirements at different ages and life stages. Our work is geared towards improving access to diagnostics for women and girls, at the lowest level of care close to where they live, through women-centric technologies and delivery models that are responsive to their needs and expectations, including self-testing and self-sampling. How long has FIND been operational? Dr Angela Muriuki: FIND was founded at the World Health Assembly, in 2003 – this is our 20^th year of operations. Our focus is on improving health outcomes in low- and middle-income countries (LMICs) through testing, and we work across the African continent. I work out of our office in Nairobi. Why the focus on cervical cancer and not any other cancers, and why now? Dr Angela Muriuki: Globally, one woman needlessly dies every 2 minutes from cervical cancer – needlessly because death due to cervical cancer is preventable through a combination of vaccination, screening and treatment strategies. The loss of a woman has devastating consequences on her family and community and those who survive sometimes have to deal with lifelong physical, mental and social consequences of the disease and its treatment.    But even though preventive and treatment measures exist, they just aren’t reaching the regions with the highest burden of disease. Limited availability of new high-performance tests, high prices, lack of public awareness, health system level gaps and stigma all create barriers to access. For example, despite the critical role that screening plays in early detection and treatment, today, we are facing a situation in which less than half of women in LMICs have ever been screened.  Evidence suggests that cervical cancer could be the first cancer to be eliminated in our lifetime. WHO has defined three ambitious targets that countries must attain by 2030 as critical markers of progress towards elimination cervical cancer as a public health problem:

• 90% of girls completely vaccinated against human papillomavirus (HPV), the virus responsible for most of cervical cancer cases;
• 70% of women screened using a high performance test by age 35 years and again by age 45 years; and
• 90% of those identified with cervical diseases are managed appropriately.

Elimination of diseases has been done before and the COVID-19 pandemic has shown us what can be achieved, in timelines previously thought impossible, when we coalesce around a common goal. Why now? Seven years away from the target, little progress has been made with approximately 25% of LMICs having introduced HPV vaccination and less than half of women living in LMICs having been screened for cancer with an even lower proportion having been screened with a high-performance test. Why now is because, to use a popular quote, the best time to get started was 20 years ago, the next best time is now. Cervical cancer is one of the many conditions affecting women in sub- Saharan Africa especially in low-income countries. What strategies are you deploying to achieve equity? Dr Angela Muriuki: One of the key drivers of inequity in cervical cancer screening is the limited access to high-performance tests for HPV. “High-performance” in this case refers to a test that can detect HPV, and this is what countries should be using as their primary method of cancer screening. HPV screening allows for early detection of the cancer-causing strains of the virus, further assessment of HPV-positive women to determine whether they have any precancerous lesions, and for treatment of those with lesions to prevent further progression to cancer. Making HPV testing widely available and affordable could expand access to more women at lower levels care. HPV testing also offers the option of self-sampling, where a woman collects her own vaginal sample using a swab either at home or in a facility. This has been shown to be more acceptable and preferrable to a pelvic exam by women without compromising quality of sample collected, and therefore offers choice to women and flexibility to the design of screening programmes.  HPV screening is limited particularly in LMICs in part due to limited awareness, high costs and limited investment. We are working on more affordable HPV testing options, including exploring options for local manufacturing, working with governments to build evidence-informed investment cases and identify strategic levers for investment within the health system to expand access to screening, and working with communities in the design and delivery of scalable solutions to drive demand for and access to HPV screening.  Screening alone contributes, but will not lead, to elimination of cervical cancer. Therefore, we are ensuring that expanding access to screening goes hand in hand with and is embedded within a holistic approach that expands access to HPV vaccination for girls and timely treatment and care for those women diagnosed with precancer or cancer.  On International Women’s Day, in partnership with KILELE Health Association, you announced the launch of a community engagement coalition to expand cervical cancer screening in sub-Saharan Africa. Can you tell us more about this collaboration and how it is poised to help in the elimination of cervical cancer especially in Africa? Dr Angela Muriuki: We are so honoured to be partnering with KILELE Health Association on this and learning from those who know what it means to survive or lose someone to cervical cancer. The community engagement coalition is a network of community and civil society organizations that will work to identify the obstacles that limit uptake of screening for the disease, raise awareness of preventive measures, advocate for urgent action to accelerate progress towards achieving national targets, and provide user-led feedback and preferences to inform development and scale-up of new testing technologies and strategies. It’s exciting because we are working with women-led community organizations to co-create scalable solutions to address health inequalities and expand access to care. These women, representing those bearing the heaviest burden of cervical cancer globally, should be shaping policies and driving action at national, regional and global levels so that policies are responsive to their needs and expectations. What are key policy actions needed to drive cervical cancer elimination in Africa? Dr Angela Muriuki: There are adjectives that we use in reference to cervical cancer that are rarely associated with a cancer – preventable, treatable, curable and eliminable. What we need now is to convert adjective to action. For a country, district, community, organization, individual looking to drive action, there are various ways to do so:  -Understand the burden of disease, who is most affected and why, what it means for a woman, her home and community, to be directly or indirectly affected by the disease. -Understand the actions associated with each of the adjectives we are using – what can we do to prevent, treat, cure, eliminate cervical cancer. -Understand the targets set by the WHO as markers of progress towards elimination of this disease as a public health problem and find out whether progress is being made in your household, community, district, country and why/why not. For instance, why are girls not receiving the HPV vaccinations they require to prevent cervical cancer? Are eligible women being screened using a high-performance screening test for early detection and treatment? -Commit to action – for example, at individual level, commit to learn about the disease and what is needed to prevent, treat, cure and eliminate; ensure those around you know about the disease and take action (girls of eligible age are vaccinated, women of eligible age are screened using a high-performance test); integrate cervical cancer elimination strategies in your work. Galvanizing action towards elimination requires strong government leadership with the political willingness, commitment and resource investment to ensure that cervical cancer is no longer a public health problem. The COVID-19 pandemic reminded us that complex problems can be solved rapidly, when we decide that they can be solved. In the words of Professor Mahmoud Fathalla, “Women are not dying because of untreatable diseases.  They are dying because societies have yet to make the decision that their lives are worth saving.”