Over one million women in 14 low-and middle-income countries have been screened for cervical cancer through an integrated prevention program, delivered by country governments in collaboration with global health agency Unitaid, the Clinton Health Access Initiative (CHAI), and Expertise France as the lead of the SUCCESS project, in partnership with Jhpiego and the Union for International Cancer Control (UICC). Over 80 percent of women who have screened positive for cervical pre-cancer have received treatment.
This is part of a broader effort to develop scalable models for cervical cancer prevention that is adapted to lower-income settings across Africa, Asia, and Latin America where nine in ten deaths from cervical cancer occur. The program has seen countries train thousands of health workers and significantly expand the number of medical facilities offering life-saving screening and preventive treatment.
The program is designed around a package of high-performing and cost-effective screening, preventive treatment, and planning tools and delivery methods, including:
- World Health Organization (WHO) tools to produce national costing plans for a prevention program using human papillomavirus (HPV) testing, which identifies the leading cause of cervical cancer and replaces a less accurate screening method based on visual inspection of the cervix.
- Introducing self-sampling methods for HPV testing, which circumvent the need for pelvic examinations–a promising technique to increase participation in screening programs.
- Supporting integrated patient monitoring tools, connected to national databases, across many program countries.
- Introducing portable thermal ablation devices, which provide a simpler and more affordable method of treating pre-cancerous cells on the cervix compared to traditional cryotherapy machines.
- Engaging and supporting civil society organizations to raise awareness within their communities of the services available, and in advocacy—essential for sustainable and long-term progress.
Additionally, the program is supporting the development of artificial intelligence-based assessment tools–an emerging innovation with the potential to improve the accuracy of visual screening methods.
Since October 2019, programs in Burkina Faso, Côte d’Ivoire, Guatemala, India, Kenya, Malawi, Nigeria, the Philippines, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe have been developing and demonstrating successful implementation of this package of care. With the program’s support, more than 250,000 women have been screened in Kenya, more than 190,000 women have been screened in India, and more than 200,000 women have been screened in Nigeria over the past three years.
By November 2022, program sites in half of these countries were achieving the World Health Organization’s (WHO) target to ensure 90 percent of women who screen positive for pre-cancerous lesions receive preventive treatment—seven years ahead of schedule, thus demonstrating effective models at a scale that are ready to be replicated in other countries and contexts.
According to WHO, approximately 600,000 new cases of cervical cancer are recorded each year, resulting in over 340,000 deaths. However, cervical cancer is highly preventable when women have access to early screening and preventive treatment. The risk of cancer is reduced, and health outcomes are improved the earlier infection is diagnosed.
Philippe Duneton, Executive Director of Unitaid comments: “With one million women reached so far, Unitaid is pleased to see that this package of effective and affordable technologies and delivery models is proving successful in fighting cervical cancer in low- and middle-income countries. We now call on governments and partners to urgently scale up these models of care and reduce the burden of cervical cancer in LMICs, where nearly all deaths from the disease occur.”
As part of the program, Unitaid and CHAI negotiated substantial price reductions for HPV tests of approximately 40 percent to less than US$9 and achieved an approximate 45 percent reduction in the cost of thermal ablation devices.
Joshua Chu, Executive Vice President, of Vaccines and Non-Communicable Diseases, Clinton Health Access Initiative adds: “Reaching one million women screened for cervical cancer through the Unitaid-funded program is a major milestone, and we recognize the efforts of the Ministries of Health to prioritize resources to ensure women have an equal chance to live healthy and fulfilled lives. However, more needs to be done to rapidly expand these services, avert 65 million more deaths from this preventable and treatable disease over the next century, and ultimately eliminate cervical cancer as a public health threat.”
Through its various outreach and education strategies, the SUCCESS project has been able to achieve a high level of acceptability of self-sampling in its four implementing countries. Indeed, nearly 88 percent of women screened used self-sampling.
Eric Fleutelot, Technical Director, Major Pandemics Unit, Health Department, Expertise France mentions: “The devotion of the Ministries of Health with whom we collaborate, through cancer control programs, as well as HIV programs, demonstrates the interest of the implementation of these innovative solutions. For our efforts to be sustainable, and thus be able to reach several million women, we need to bring in more financial partners to this fight. The SUCCESS project has been pursuing various avenues to secure and expand funding streams, such as through other partners like L’Initiative and the Global Fund.”
Dr. Bente Mikkelsen, WHO Director for Noncommunicable Diseases: “We applaud the 14 countries’ achievement in reaching over one million women with services to prevent cervical cancer. WHO is pleased to work with United and its partners, demonstrating that, with innovative collaboration, the 90-70-90 elimination targets are achievable. Together, we must build on the momentum and support countries to bring services to scale, until women everywhere have access to the dignified care they deserve.”
