Summary of Year 1
During the first year of the Alliance, several projects have begun assessing innovative approaches to screening and treatment of precancerous lesions. Community involvement activities and service delivery assessments (particularly development of appropriate training protocols and guidelines) have been key components of these projects, together with technology assessments and advocacy efforts. Highlights of this work are described below.
Screening and Treatment Technologies
The Alliance has taken major steps to better understand the safety, effectiveness, and feasibility of various approaches to screening and treating precancerous cervical lesions. Alliance partners are implementing or providing technical assistance to research and demonstration projects in 17 countries in Asia, Africa, and Latin America. These projects are assessing a range of program strategies, including VIA (visual inspection with acetic acid) plus immediate cryotherapy for positive cases, testing for the human papillomavirus (HPV) with standard diagnosis/treatment, and strengthening cytology-based programs. (Click here to view more detailed information about these programs.)
The projects are implemented in collaboration with local organizations, Ministries of Health, and universities. They are producing a rich database that will be crucial to making rational, data-based recommendations on cervical cancer prevention strategies in low-resource settings. Of particular interest are encouraging results for approaches to visual inspection with acetic acid, HPV testing, and the use of cryotherapy for outpatient treatment.
Service Delivery
During the past year, Alliance partners have begun developing a number of guidelines and training manuals to ensure the high-quality delivery of new cervical cancer prevention interventions:
- a complete training package for VIA and cryotherapy, including a manual, Guidelines for Cervical Cancer Prevention in Low-Resource Settings, and an atlas of cervical photos;
- a training manual and atlas of cervical photos for use in training for colposcopy and VIA/VIAM;
- a manual for home-based palliative care for patients with terminal cervical cancer (in part as a response to country partners who requested assistance in meeting the needs of women with advanced cervical cancer likely to be identified through new screening programs);
- training modules for VIA and cryotherapy in Spanish, and technical manuals for palliative care to meet the needs of cervical cancer programs.
Alliance partners also are developing other resources that programs can use to help define and ensure the quality of their cervical cancer prevention services. These include quality assurance guidelines and strategies for cytology laboratories, a template and approach to country program evaluation, a quality assurance system for VIA and cryotherapy, and an assessment tool to help health programs assess their capacity to offer cervical cancer prevention interventions. As part of ensuring sustainable service delivery strategies, all partners are integrating cost-effectiveness models into one of more of their projects.
Community Involvement
All Alliance projects have taken steps to educate and inform women and their communities about cervical cancer, the need for screening, and where to go for services. For example:
- In a South African screening project, staff regularly reach out to the community about cervical cancer prevention, including participating in a radio call-in program on health issues. In Peru, Alliance members are working together to lay the groundwork for a project that is defined by and responsive to community needs. Particular areas of focus will be encouraging better interactions between health care providers and their patients, developing culturally appropriate educational materials, and developing community-based systems for identifying and supporting women at risk of cervical cancer.
- In a Thailand project, village health volunteers educate women about the importance and availability of VIA services in local health centers. Because these volunteers know the community members, they also can monitor women treated with cryotherapy to ensure they return to the clinic for appropriate follow-up care.
- A study in India is investigating the impact of intensive, community-based health education on increasing the likelihood of earlier diagnoses of precancer.
- A PAHO workshop entitled "Women's perceptions: screening for cervical cancer" fostered discussion of community and client issues among representatives from several Latin American cervical cancer control programs.
The Alliance Small Grants Program also has enriched community involvement efforts. The Small Grants Program encourages local organizations to assess community needs and concerns that are likely to affect program success.
Advocacy
A significant effort has been made in the first year of the project to further inform and educate policymakers, health care providers, and communities about cervical cancer and feasible prevention strategies. Part of this effort has involved educating international agencies and scientific/medical organizations about the Alliance.
In the past year, 15 new papers related to Alliance work were published or are in press in refereed scientific journals. Other materials developed during the past year include a revised version of a widely-distributed issue of Outlook on cervical cancer, background papers on HPV testing and HPV vaccines, the first in a series of fact sheets on cervical cancer prevention, guidelines and technical information on VIA and cryotherapy, and two videos exploring women's experiences with cervical cancer and prevention services in South Africa. IARC continues to contribute to the global information base on cervical cancer incidence, and produced new incidence and mortality estimates for 2000.
Key to advocating for improved cervical cancer prevention programs is involving those in a position to effect changes at a local or national level. For example, Alliance members have established project advisory boards composed of representatives from the Ministry of Health, health professional training institutions, health professional associations, and women's advocacy groups, as well as formal agreements with local health services and national programs to ensure sustainability.
Work has begun on a survey of key policy/decision-makers in developing countries to gain insight into their information needs related to cervical cancer prevention. Surveys have been carried out in Kenya and will continue in Peru, South Africa, and other countries where Alliance projects are being implemented. The results of this survey will ensure that cervical cancer information that is developed is appropriate to the needs and preferred information sources of key policy-makers.
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