The HIV/AIDS epidemic may have contributed to the high incidence of cervical cancer in Zambia, where the number of cases is the second highest in sub-Saharan Africa, and HIV prevalence is one of the highest in the world.
Women infected with HIV are thought to be three to five times more likely to develop cervical lesions that can become cancerous. "In a suppressed immunity due to HIV, the virus that causes AIDS makes women more at risk from infection," said Prof Groesbeck Parham, co-director of the Cervical Cancer Prevention Programme in Zambia.
"Before the advent of ART [antiretroviral treatment], women had a shorter life expectancy, making it more unlikely for the pre- and early cancers to develop into full-blown cancer, a disease that takes between 10 to 20 years to grow," he said.
Zambia has a national HIV prevalence rate of 14 percent, but a recent study found that 16 percent of women were positive, whereas 12 percent of the total were men.
Pap smear tests, which detect cervical cancer, are conducted at selected health centres, but the tests are expensive and require patients to make a number of visits to the health facility before a final diagnosis can be made, so too few women are being tested.
"Cervical cancer claims the lives of many women in Zambia because it is detected when it's too late to treat it effectively ... but now, thanks to the prevention programme, we have saved the lives of over 7,000 women who would otherwise have died," Parham noted.
The initiative, under the aegis of the Centre for Infectious Diseases Research in Zambia (CIDRZ), is running at 15 clinics in three cities located in two of the country's nine provinces, including the capital, Lusaka, and has tested over 26,000 women in three years.
|Cervical cancer claims the lives of many women in Zambia because it is detected when it's too late to treat it effectively|
A third of the women seen at the clinics are HIV positive, while another third do not know their status. "We decided to integrate VCT [voluntary counselling and testing] services after realizing that most women referred to the VCT clinic never reached the [cervical cancer] testing centre. The short distance between the cervical cancer clinic and VCT centre was long enough to make them change their minds," Parham commented.
A 2004 study of 150 women with advanced HIV revealed that 94 percent had some form of cancer; the remaining six percent tested negative. These findings prompted the roll-out of the Cervical Cancer Prevention Programme, funded by the US President's Emergency Plan for HIV/AIDS Relief (PEPFAR).
Primary responsibility for screening and providing treatment is in the hands of non-physicians such as nurses, while community-based health-promoters educate people about the programme and the services, which are available at most public health centres.
"Zambia is facing critical human resource problems and we decided to look at other available resources to help us run the programme," said Prof Stringer, the Director of CIDRZ.
Josephine Simwiinga worked as a nurse at Lusaka's Chilenje clinic. "I saw different cases of pre-, early and advanced cancers. If the condition was not complicated, we would see [the patient] and treat [her] immediately; cases that are complicated are referred to the University Teaching Hospital (UTH) via email," she said.
A computerized screening process makes this possible. After explaining the screening process to the client, Simwiinga takes a digital picture of the cervix, transfers it to the laptop, shares the findings with the patient and then sends the picture to a consultant at UTH. The 15 centres are integrated and linked to government health centres.
Yet cervical cancer is still a major threat to women living outside of the Lusaka and Southern provinces, where the programme is operating. Theresa Mutale, 58, has been living with HIV for 10 years in Mungwi District, Northern Province.
"I have heard about these services but they are for [people] living in Lusaka and Southern provinces. I have been on treatment for some time now and my chances of having cervical cancer are quite high, based on the information I have, but there is nowhere nearby we can access treatment. The nearest is Lusaka, which is over 850 kilometres away."
Parham acknowledged that the project needed to be scaled up. "If we work collaboratively with all the partners, with the ministry of health taking the lead, we can roll out the programme throughout the country. We need more women to access the service."