Highlights of Alliance Work

Alliance projects have worked to assess innovative approaches to screening and treatment of precancerous cervical lesions. Community involvement activities and service delivery assessments have been key components of these projects, together with technology assessments and advocacy efforts. Highlights of this work are described below.

Alliance partners are developing models for appropriate, affordable, and efficacious screening and treatment technologies.

Alliance partners are working to refine our knowledge about low-cost visual testing methods for cervical cancer prevention—VIA (visual inspection of the cervix using acetic acid), VIAM (using added magnification), and VILI (using Lugol’s iodine). Alliance members also are continuing to investigate the performance of HPV DNA testing as a screening method and to demonstrate the effectiveness of treatment for precancer via cryotherapy administered in field conditions by nonphysician or nonspecialist providers. Alliance projects have provided evidence that nurses can perform screening, diagnosis, and treatment procedures effectively at local primary health care facilities. Altogether over 160,000 women had been screened through Alliance projects as of August 2002, and approximately 8,000 women had undergone treatment by cryotherapy, LEEP, or other methods.

Highlights of Alliance work in the area of screening and treatment technologies include:

• Compelling initial results for VILI screening: early data indicate the sensitivity of VILI to be higher than that of VIA, with specificity similar to VIA. The Alliance will continue exploring the possible advantages and disadvantages to this approach.
• Field-testing various cryotherapy units to identify a model that will function most effectively and that can be readily acquired and maintained in low-resource settings. Projects also have investigated alternative infection prevention procedures for cryotherapy probes. In addition, the Alliance has undertaken a large systematic review of the literature assessing the effectiveness, safety, and acceptability of the use of cryotherapy in less developed countries. Through the individual projects, Alliance partners will continue to monitor and evaluate the effectiveness, safety, and acceptability of cryotherapy in low-resource settings.

Alliance partners are developing recommendations/models for appropriate, affordable, and efficacious service delivery.

Alliance partners are continuing work to improve the delivery of cervical cancer prevention services. Having rational service delivery guidelines in place and adopted by country programs is key to ensuring that high-quality services will endure over time. Partners are exploring a wide range of service delivery approaches. For example:

• One project is based on cytologic screening and treatment with LEEP, but its guidelines and materials developed will be adaptable for use with other approaches in low-resource settings.
• Project partners have developed a cervical photo atlas, a manual of colposcopy, and a curriculum for teaching VIA to healthcare providers. Quarterly photo quizzes for health workers performing VIA screening provide feedback to health workers and their supervisors.

All project findings will feed into an ACCP Service Program Guide to be produced in 2004.

Recommendations are being developed for appropriate, affordable, and efficacious strategies of increasing demand for cervical cancer screening services by involving communities.

Involving communities in the development of cervical cancer prevention services is vital to ensuring that programs will be accepted and integrated into routine health services, and will succeed over time. Alliance partners have learned much about the needs and concerns of women and communities in the past year, and about the barriers women face in seeking health services. Alliance projects are examining these issues from many angles. For example:

• Building onto an existing "life skills" curriculum for men a section focusing on cervical cancer prevention and the importance for men of encouraging the women in their lives to seek screening and to comply with post-treatment abstinence requirements.
• A pilot-test is examining an intervention to improve women’s satisfaction with their care via increased client-provider interaction and facility improvements.

Alliance members are compiling a multi-country descriptive analysis of various community involvement interventions. Through this multi-country analysis, the Alliance can bring together a wide range of activities encompassing such issues as screening among hard-to-reach populations, increasing male involvement, and developing strategies for supporting women with advanced cancer.

Appropriate and effective awareness-raising strategies are being developed to gain broad-based support for the implementation of effective cervical cancer prevention policies and programs.

Efforts to raise awareness and gain support for effective cervical cancer prevention will be greatly strengthened by working collaboratively. Accordingly, Alliance members have committed to an ambitious schedule of joint publications and materials such as fact sheets, and power point presentations that can be used globally by health advocates. Alliance partners will continue to give joint presentations at conferences and hold joint meetings with representatives from international foundations and other colleague organizations. Plans are in place for the Alliance to present findings at the November 2003 conference of the International Federation of Obstetrics and Gynecologists.

Localized advocacy efforts will continue in the countries in which ACCP projects are under-way. Alliance members are building local support for cervical cancer prevention and learning how best to integrate programs into wider national health care systems.

For example:

• Alliance partners in one country have facilitated the establishment of a national planning and advocacy group to assist with cervical cancer prevention projects, explore revisions to national policies, and seek increased financial support for cervical cancer prevention.
• Advocacy meetings and trainings have been held with health officials and professional organizations in a number of countries from Latin America to India.

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