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Increasing access to cervical cancer screening for women living with HIV in East Central Uganda

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 Success Story on Increasing access to cervical cancer screening for women living with HIV in East Central Uganda

Cevical cancer is the fourth most common cancer among women worldwide and the commonest among women in Uganda (35.5% of all new cancers among women).  There is a significant and increasing burden of cervical cancer in Uganda (6,413 new cases and 4,301 deaths annually).  A survey done at  13 regional referral hospitals Uganda by Clinton Health Access Initiative (CHAI) and the Uganda  Ministry of Health found that 33.7% of women living with HIV had a positive Human papillomavirus (HPV) test, a prevalence way above that of the general population.

Cervical cancer is largely preventable through screen-and-treat programs for pre-cancerous lesions which rely on simple, inexpensive, and easy-to-use tools that can be delivered at the lowest level of care. Just two lifetime screenings can reduce the risk of developing cervical cancer by half.

Despite the benefits, fewer than 1 in 10 Ugandan women have been screened for cervical cancer in the last 5 years.

 To support the Global strategy to accelerate the elimination of cervical cancer as a public health problem, the US President’s Emergency Plan for AIDS Relief (PEPFAR) supported the MOH to systematically roll out cervical cancer screening country wide, targeting women living with HIV aged 25-49 years.

In East Central Uganda, the USAID Local Partner Health Services East Central (USAID LPHS-EC) works at site level to directly supports accredited government  health facilities to scale-up cervical cancer screening activities. Collaboration. USAID LPHS-EC  above site partner USAID Regional Health Intergration to Enhance Services in East Central Uganda (USAID RHITES-EC) is leading the trainings health workers in screening for cervical cancer as well as district level health system strengthening activities supporting  reporting, stakeholder accountability, performance  management and strengthening health system support for ordering and management of supplies from the national drug and medical commodity warehouses.

Sr.Judith, a midwife at Masafu Hospital, Busia district, is excited about the fact that cervical cancer screening is now available for women living with HIV in her community. She is one of two health workers at the hospital initially trained to screen and treat women with precancerous lesions that may develop into the deadly disease.

“A lot of women died because they did not have access to early screening. I’m excited to offer this life saving service at Masafu” said Sr. Judith. Judith’s passsion is infectious & she’s already passed down her knowledge kills from the training  –  conducted by USAID LPHS-EC implemented by Makerere University Joint Aids Program (MJAP) –  to other colleagues in the Masafu Hospital HIV treatment clinic.

 Once the cervical cancer screening services were kickstarted in early 2021, demand for cervical cancer screening i tremendously increased and quickly depleted  the intial supplies provided before  the due time for the health facility to receive it’s next delivery of cervical cancer screening commodities from the national warehouse. Masafu Hospital led by its cervical cancer screening focal person, Sr.Judith, quickly innovated to avoid service disruption.

 Sr. Judith subsequently collaborated with her colleagues from other hospital departments and the district medicines management supervisor who together with RHITES-EC facilitated the redistristribution of required commodities from lower level heath centers who still had adequate stock of screening commodities.

 “The supplies reduced but we tapped into locally available resources” Sr. Judith says.

Sr.Judith leadership in cervical cancer screening at Masafu Hospital has yielded outstanding results in terms of quality and volume of clients served. Masafu Hospital, which is Busia distict’s highest volume health facility is among the leading facilities in the region in regards to cervical cancer screening. To date, a total of 232 women living with HIV have been screened for cervical cancer at Masafu Hospital. This represents 213% of the quartely facility target which contributes 53% of the facility’s annual target. This performance is above the regional average performance which currently stands at 20% of the annual target in the 1st quarter.

To Shakirah, 25, a single mother of three, who is living positively with HIV, the screening at Masafu Hospital has saved her life, and that of her children. She was screened and found with pre-cancerous lesions which were immediately treated.

 “In 20 minutes I had finished, received the necessary treatment.I was also given a followup appointment. The screening has saved my life” says Shakira.

 Asked about how Masafu hospital is able to sustain the good performance, Judith says that having available cervical cancer screening commodities,the consisent health education in the clinic, and personalised discussions with clients about the proceedure has increased demand. She says that most of the eligible women approached have consented to the checkup.

 “With our clients we make sure to address any anxiety and build confidence in the proceedure. Demand for cervial cancer screening is high because of the health education in ART, privacy during the procedure and our high standards of infection prevention” says Judith.

 Its clear that commited leadership and teamwork between health workers in various departments can improve access to cervical cancer screening amidst challenges like limited supplies.

Figure 1: Shows the weekly trend from October to December 2021 in cervical cancer screening in the region with consistent improvement and performance above the target of 300 women a week since November 2021 with a drop at the end of December attributed to the holiday season.

Pull-out Quote:  “With our clients we make sure to address any anxiety and build confidence in the proceedure. Demand for cervial cancer screening is high because of the health education in ART, privacy during the procedure and our high standards of infection prevention” says Judith.

 

 

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