By Guillermina Tivir, Nurse, PSI Mozambique; Marcos Chissano, Director of Evidence, PSI Mozambique; Hannah Hoover, Director of Programs, PSI Mozambique; Paul Bouanchaud, Senior Research Advisor, PSI; Dr. Eva Lathrop, Global Medical Director, PSI
In one year, 1 in 2 women with cervical cancer will die from the disease – with the majority of deaths occurring in low and middle-income countries.
It doesn’t have to be this way. With the right resources, we can eliminate cervical cancer. But to get there, we need buy-in from all.
That is why PSI works with governments and partners philanthropic and commercial sectors to support countries to achieve the WHO’s global cervical cancer elimination goals.
This Cervical Cancer Awareness Month, we are spotlighting PEER Mozambique – a program aimed to introduce and scale-up innovative Cervical Cancer Screening and Preventive Therapy (CCS&PT) approaches in Mozambique. This work is implemented in conjunction with voluntary family planning activities focused on generating evidence to inform sustainable scale-up of cervical cancer control programs in lower- and middle-income countries.
PEER partners included The University of Texas MD Anderson Cancer Center, Population Services International (PSI) Washington and PSI Mozambique, Rice University, The Ministy of Health Mozambique (MISAU), The Universidade Eduardo Mondlane Faculty of Medicine (UEM) and the Clinton Health Access Initiative (CHAI).
PSI Mozambique alongside its partners in the PEER project saw a number of key achievements from January 2020 – December 2022. Despite facing considerable challenges, including the COVID 19 pandemic, difficulties with procurement and supply chain, lab availability, and issues around sample transfer, we enrolled and screened over 9,000 women for cervical cancer and pre-cancerous lesions.
The vast majority of PPER study participants (94 percent) chose to collect theor own sample rather than doing a pelvic exam with provider for HPV testing. Since these tests are essential for primary cervical cancer screenings, this urges us to consider approaches to HPV testing that can be done at home via Community Health workers (CHWs). Exploring this model can help overcome health facility access barriers and build self-sampling confidence and agency among women as cervical cancer screening with HPV DNA testing expands.
To integrate family planning and CCS&PT, participants preferred a model where health services are completely integrated, with one queue, one provider, and one room. While funding streams and mandates for these two services may be different, making integration challenging, a fully integrated family planning and CCS&PT service could increase health service uptake, improve health outcomes, and support advocacy for the design of services more responsive to women’s needs and preferences.
Testing & Treatment Rates
Ensuring that women are aware of HPV testing results and return for follow-up treatment is labor intensive. Among our current study participants, over 95% of women with HPV+ results have been treated with thermoablation or cryotherapy or referred to specialty care. The sooner we can reach a participant after sample collection the better – and anecdotally – the more likely she is to follow up for results and treatment.
While we follow-up with test results and explain treatment options we also work to maintain participant privacy and agency in health decision-making. We know that results reporting outside of a clinical trial environment like PEER is uneven, and depends on personnel, funding, and mandates. We suggest that a point-of-care test with the ability to have same-day results will be critical to avoid loss to follow-up, and any future expansion will need to take this into account when designing personnel allocation and budgets.
PEER’s success in Mozambique would not have been possible without the dedication, commitment to excellence, and the expertise of our PEER nursing staff. Capacity building and intensive training from the MD Anderson team has helped to maximize the impact of our nurses who have demonstrated excellence across the board. The formula of low dose, high frequency training allows uninterrupted service, is cost effective, and leads to sustainable capacity.