1. We know what to do: the unfinished agenda and priority next steps
Eliminating Cervical Cancer, IAS meeting, Paris, 25 July 2017
Vivien Tsu, PhD MPH
Associate Director,
Reproductive Health

2. Every 2 minutes a woman dies from cervical cancer…
HPV vaccine holds great promise—girls vaccinated now will be largely free of cervical cancer in the future.
BUT, backlog of 700 million women in LMICs aged in 2015, who could be saved by screening in next decade.
HIV+ women are at particular risk

3. Burden of cervical cancer falls mainly on the poor
Cervical cancer is the leading cause of cancer death in 38 countries, most of them in Africa where HIV prevalence is also high.
Mortality rates in highest regions (Eastern Africa) are 18 times higher than in lowest regions (Australia/NZ).

4. HPV vaccine:
-Gavi and PAHO have lowered vaccine prices
->20 LMIC demo projects
-2-dose schedule
-9-valent vaccine
Scaling up screening:
-Several countries expanding beyond pilots
-Regional learning
-Growing political support
Recent advances
Screening technologies:
-Self-collected HPV tests
-VIA as good starting place and needed for treatment selection
Management algorithms:
- Good evidence for screen and treat approaches
-New WHO guidance
-Models help guide program choices
Pre-cancer treatment technologies:
-2 new portable thermal coagulation devices

5. Supportive health systems for cervical cancer prevention
Better data systems:
-Common indicators identified
-More electronic systems
-Promising mHealth tools
Integration with other services:
-PEPFAR supporting cervical cancer screening in HIV programs in some countries
-Family planning services offering screening
Financing:
-Cost estimated for next 10 years
-WHO/CDC costing tool available
-Global Fund and GFF can cover cervical cancer prevention
Communication and advocacy:
-Good evidence for effective messages and channels
-Several global and national coalitions

6. Near-term Priorities HPV vaccine Screening tests Pre-cancer treatment
Move more countries to national scale; vaccinate 30 M girls by 2020
Evaluate 1-dose regimen
Countries use tools for effective planning
Disseminate evidence on impact
Screening tests
Establish QA protocols for HPV testing and VIA
Pre-cancer treatment
Incorporate thermal coagulation into global and national guidelines
Management algorithms:
Establish evidence-based algorithms for screening frequency, triage, etc. for general population and HIV+
Match algorithms to resource levels
Scale up screening
Additional 5-10 countries have pilots that could be expanded
Facilitate regional cooperation and cross-learning

7. Priorities for Supportive Health Systems
Better data
Incorporate cervical cancer indicators into routine data systems
Develop tracking systems to ensure screen-positive women receive treatment
Integration with other services
Remove barriers and enhance coordination with other programs that serve women and use overlapping resources
Identify and evaluate integration models that optimize resource use and convenience for women
Financing
Identify more funds (national and donor) to cover start-up and expansion of screening
Negotiate lower prices for HPV vaccine for non-Gavi and for HPV tests
Communication and advocacy
Strengthen advocacy partnerships
Harmonize advocacy messages
Focus on cervical cancer prevention, not HPV prevention
Support national champions and coalitions

8. Rationale for increased investment
Prevention is very cost-effective (a “best buy” according to WHO), especially for HIV+ women—they have greatest risk and health platform is already in place.
Amplifies the benefits from other health system investments (such as staff, data systems, procurement systems, supply chains) by extending beyond traditional health issues to high-return programs like cervical cancer prevention.
Can pave the way for the broader fight against all cancers.

9. Eliminating cervical cancer
...we are always faced with making sufficient decisions based on insufficient information. If we had waited until all the answers were available, the work on smallpox eradication would never have started—selecting the target helped develop the appropriate tools and strategy.
Elimination of smallpox in 1977 showed value of immunization and led to creation of EPI.
For cervical cancer, the basic tools are already available.
Growing awareness that cervical cancer prevention is critical for women living with HIV.
Our target is clear. Starting with HIV+ women, we must reach ALL women at risk and eliminate cervical cancer as a public health problem.
Bill Foege, 1998

10. http://bit.ly/2u0TujB Thank you! Vivien Tsu, PhD, MPH
Cervical Cancer Prevention: Recent Progress and the Unfinished Agenda in Low- and Middle-Income Countries
Guest Editor: Vivien Davis Tsu
IJGO Supplement Editor: Claudio Sosa
Thank you!
Vivien Tsu, PhD, MPH
Associate Director,
Reproductive Health Program,