It’s time for global cervical cancer funders to prioritize HPV testing.

Posted September 8, 2021
Impact Area Sexual & Reproductive Health

This piece was originally featured on the TogetHER for Health blog.

The world has a new blueprint to save millions of women – including many women living with HIV – from dying of cervical cancer. How long must women around the world wait to see that promise fulfilled?

Last month, the World Health Organization (WHO) published updated guidelines for screening and treatment of pre-cancer lesions for cervical cancer prevention, providing a clear mandate and scientific rationale for global adoption of human papillomavirus (HPV) testing as the recommended screening method for women worldwide.

To put it more simply, it’s a plan for a smarter, faster, and more effective end to cervical cancer around the world. Implementing this guidance can vastly multiply the number of women being accurately screened, allow for more efficient allocation of women’s health resources, and reduce reliance on less-reliable and often more-invasive screening interventions.

Converting this guidance into programs in low- and middle-income countries can put the world on the path toward ensuring that 70% of all women receive screening for cervical cancer at ages 35 and 45, a key pillar of the WHO’s strategy to accelerate the global elimination of cervical cancer.

This guidance is the product of years of productive collaboration between experts, communities, and funders. Notably, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and the Global Fund to Fight AIDS, Tuberculosis and Malaria all contributed to this groundbreaking process.

Together, these key organizations provided two-thirds of all funding for cervical cancer screening and treatment programs in low- and lower middle-income countries in 2019, placing them in a unique position to not just influence guidelines but to concretely implement that guidance in the programs they fund.

TogetHER and AVAC have rallied a coalition of 39 organizations advocating for the global elimination of cervical cancer to acknowledge the roles that PEPFAR, the Global Fund, and USAID have played in combating cervical cancer in low-resource settings and in creating these new guidelines.

More critically, our coalition is calling on these major funders to communicate their process and timeline for prioritizing HPV testing as the primary method for cervical cancer screening in the programs they support. Committing to the broader use of HPV testing within these programs demonstrates a clear commitment to quality of care for women, especially those living with HIV.

The world has made clear its dedication to end cervical cancer everywhere. With leadership from these major donors, the ambition of cervical cancer elimination can be translated into reality.

We know how to eliminate cervical cancer. It is now a matter of when this goal will be achieved.

TogetHER for Health
AVAC
American Cancer Society
FHI 360
Global Communities
Jhpiego
PATH
Pathfinder International
Population Services International
Advocates for Youth
AIDS Action Baltimore
American Medical Women’s Association
BIO Ventures for Global Health
Cervical Cancer Action for Elimination

Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor
Conquering Cancer
CureCervicalCancer
Elizabeth Glaser Pediatric AIDS Foundation
ENGAGe Teens
EngenderHealth
ESGO Prevention Committee
Global Focus on Cancer
Global Initiative Against HPV and Cervical Cancer (GIAHC)
Go Doc Go
Grounds for Health
Haiti sans Cervical Cancer
Housing Works

IAVI
Innovating Health International
International Association of Providers of AIDS Care
John Snow International
KILELE Health Association
Kizazi Chetu
Management Sciences for Health
MSI Reproductive Choices
Scope
Treatment Action Group
VCS Foundation
International Taskforce on Cervical Cancer Elimination in the Commonwealth

Check out the video below to see how PSI Caribbean and Ayana Dyette Foundation for Cervical Cancer’s (ASDF) strong partnership has created an environment for growth and sustainability for cervical cancer awareness and advocacy in Trinidad and Tobago.

Banner photo credit: “Pineapple farm and rural village, Lao PDR” by ILO in Asia and the Pacific

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.

Building community health worker capacity to deliver malaria care

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Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.

For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

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Promoting self-managed care like Self-testing and Self-Sampling

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Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

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Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

It’s time for global cervical cancer funders to prioritize HPV testing.

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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