THE Center for Diseases Control (CDC) has scaled up Cervical Cancer and treatment in Zimbabwe in a bid to reduce the high mortality and morbidity associated with the disease in Zimbabwe.
By Michael Gwarisa
According to official statistics from the Ministry of Health and Child Care (MoHCC), Cervical Cancer kills not less than 2000 women annually and majority of affected women are women living with HIV.
In its 2019 Annual report, CDC Zimbabwe 2019 said HIV remains an important risk factor for cervical cancer, with HIV-positive women 4-5 times more likely to develop cervical cancer compared to HIV-negative women.
The Zimbabwe Demographic and Health Survey (ZDHS) 2015 reported 79% of women had heard of cervical cancer but only 13% ever had a cervical examination. Many women were therefore surviving HIV but dying from cervical cancer, a condition that is both preventable and curable. In order to address this critical need and associated gaps, CDC Zimbabwe introduced cervical screening using visual inspection with acetic acid and cervicography (VIAC) and treatment with cryotherapy, thermal coagulation or Loop Electrosurgical Excision Procedure (LEEP) in a see and treat approach in FY19.
“CDC Zimbabwe and its clinical implementing partners introduced and scaled up cervical screening across all CDC supported districts thereby preventing women from developing cervical cancer. This was done through the integration of cervical cancer screening into existing HIV services, extensive technical support and revitalization of existing VIAC sites, recruitment and training of nurses and doctors who conduct cervical cancer screening and treatment, setting up of new VIAC sites to increase coverage and access, and demand creation among HIV positive women,” said CDC.
CDC has also supported the revitalization of 39 VIAC sites and set up 12 new VIAC sites. To build human resource capacity, 72 nurses, 5 doctors, 3 clinical officers and 13 mentors/coordinators were trained quality cervical screening and treatment in CDC supported districts and facilities.
“During FY19, CDC supported the revitalization of 39 VIAC sites and set up 12 new VIAC sites. To build human resource capacity, 72 nurses, 5 doctors, 3 clinical officers and 13 mentors/coordinators were trained quality quality cervical screening and treatment in CDC supported districts and facilities.”
Meanwhile, CDC and its clinical implementing partners International Training & Education Center for Health (ITECH) and Zimbabwe Association of Church-related Hospitals (ZACH) rapidly scaled up VIAC over FY19, achieving a remarkable 75% of the annual target as illustrated in Figure 6 below.
“A total of 36,127 HIV positive women aged 25-49 years were screened. Service provision started at only 33 high volume sites in early Country Operation Plan (COP) 18. At the end of COP18, 48 facilities were providing VIAC, supported by direct service delivery (DSD) health care workers recruited and/or trained and deployed by CDC partners.
“The successful introduction and implementation of the program was a result of close collaboration between CDC and its Implementing Partners (IPs) and the MoHCC, recruitment and training of additional health care workers (HCWs) with a focus on VIAC, setting up VIAC sites within Opportunistic Infections (OI)/ART clinics, demand creation through integrated treatment literacy health education talks, and intensive site support and supervision to monitor implementation fidelity and provide on-site mentorship.”
However, while encouraging screening numbers were achieved, treatments rates for eligible women were lower than expected as illustrated in Figure 7 below.
“Although the positivity rate of 8% is within the expected range, the treatment rate falls short of the expected minimum of 70%. In the coming year, CDC will prioritize efforts to increase coverage of access to treatment services for all eligible women while strengthening the referral system for those women requiring advanced treatment procedures that may not be available locally.”