2. National Coordinator Cancer Prevention Ministry of Health Zambia
Dr. Sharon Kapambwe
National Coordinator
Cancer Prevention
Ministry of Health
Zambia

3. Conflict of Interest
No conflicts of interest to declare.

4. BACKGROUND
Invasive cervical cancer is one of the commonest malignancies worldwide
Accounts for 22% of estimated new female cancer cases in sub-Saharan Africa
Most common cancer in adult population in Zambia (over 30%)

5. HIV and Cervical Cancer
HIV infected women at much higher risk for incidence, progression and persistence of cancer causing HPV infection
Present at younger age with cervical cancer
More rapid progression of chronic persistent HPV infection
Relative immunosuppressive state
Limited to nonexistent cervical cancer screening services

6. The Zambian Programme A country of 16 million people
Life expectancy 60 years
56% live in rural areas
HIV prevalence 13.3%

7. Zambian Context-2003 Physician patient ratio: 0.12/1,000
Raging HIV epidemic (HIV Prevalence 16.5%)
Increasing cervical cancer cases
No chemo-radiation treatment centre centre
Limited cytology based screening doctor led
No HPV vaccination
25 gynecologists in the nation
6 pathologists in the public sector
No cytologists
Competing priorities
Most of our countries could be here

8. Gynecol Oncol 2006; 103:
screened 150 consecutive in 2004, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. collected cervical specimens for cytological analysis by liquid-based monolayer cytology (ThinPrep Pap Test®). HPV typing using the Roche
Linear Array® PCR assay. median age of study participants was 36 years (range 23–49 years). their median CD4+ count was 165/μL (range 7–942).

9. Local solutions Visual Inspection with Acetic
(available, low-cost, same-visit, and optimally accurate)
Inadequate laboratory infrastructure to support cytology based-screening
Treatment of pre-cancer that is setting-appropriate , lower cost, and relatively easily implemented
Cryotherapy- Challenges encountered
Thermal coagulation offers better alternative
Local training program for nurses and doctors in VIA, Cryotherapy and LEEP
Introduction of innovation: “electronic cervical cancer control”—eC3
Point of care data electronic data collection
Distance consultation
Monitoring and evaluation
Continuing medical education
Patient education
Develop local solutions Distance consultation, Use of technology to circumvent prevailing challenges.

10. Program Implementation 2006
Integrated into two government-operated public health clinics
Nurse led, VIA based, “Screen and Treat” platforms
Government and PEPFAR/CDC-supported
Target HIV-infected women
Open to women with HIV uninfected and unknown status
HIV testing offered

11. 1 2 3 Three-Phase National Scale-Up with government ownership
Provincial hospitals
- Nursing schools, functioning theatre
- VIA, Cryotherapy, LEEP 2
District hospitals
- VIA, Cryotherapy +/- LEEP
Scaling up to national levels through a thorough process 3
Health facilities
- VIA, Cryotherapy

12. 2006
One district- 04 clinics

13. Cervical Cancer Screening Clinics in Zambia (2017)
Nchelenge
Chienge
Kaputa
Mporokoso
Mpulungu
Mbala
Nakonde
Kawambwa
Mungwi
Kasama
Isoka
Luwingu
Mwense
Chinsali
Chilubi
Chama
Mansa
Samfya
Mpika
Mwinilunga
Milenge 1
Solwezi
Lundazi 3 2 4 5 6
Lufwanyama 7
Chavuma
Masaiti
Serenje
Mufumbwe
Zambezi
Kabompo
Mambwe
Mpongwe
Kasempa
Mkushi
Petauke
Chipata
Kapiri Mposhi
Katete
Chadiza
Lukulu
Kabwe Urban
Nyimba
Kabwe
Kaoma
Mumbwa
Chibombo
Kalabo
Mongu
Chongwe
Lusaka (12)
Taken a decade for most districts to access screening services
Luangwa
Key:
Itezi-Tezhi
Kafue
Senanga
Namwala
Mazabuka
1. Chililabombwe
Monze
VIA only
Shangombo
Siavonga
2. Mufulira
Choma
3. Chingola
LEEP and VIA
Gwembe
4. Kalulushi
5. Kitwe
Sesheke
Kalomo
Sinazongwe
Kazungula
6. Ndola Urban
Livingstone
7. Luanshya
Carried forward from 1997:
45,180.
Supplied in 1998:
33,160 UNICEF
34,000 JICA
Total:
112,340
Minus stock carried forward to 1999:
42,288
TOTAL CONSUMED IN 1998:
70,052
Total forecast:
132,000
% of forecast consumed:
53%

14. Achievements
Cervical cancer screening part of HIV treatment guidelines, HIV linkages in National Cancer Control Strategic Plan
Linkages with HIV care and treatment clinics
Close to 370,000 women screened, 29% HIV infected
HPV vaccination demonstration done, national scale planned
Establishment of chemoradiation centre with in patient facilities
Increased number of partners

15. Challenges Funding limited for cervical cancer
Still not “mandatory” for women living with HIV to get screened for cervical cancer
Integration needed between cervical cancer screening and HIV
HPV vaccination for adolescent and screening needed

16. Recommendations Make cervical cancer screening part of HIV care
Strategies needed for adolescents living with HIV to be vaccinated and screened
Research on HPV infection in adolescents needed
Increased funding base for cervical cancer screening

17. Acknowledgements Ministry of Health, Zambia
Centre for Infectious Disease Research in Zambia
Co-operating partners
The nurses, doctors and all support staff working in screening centres around the country
The International AIDS Society for this session
Women of Zambia for advocating and accepting this programme
UN Agencies, Global Fund, PRRR, PEPFAR funded NGOs, Civil Society inc. Cancer Support Groups,