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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:

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:

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.

Plans for Year 2

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