Cervical Cancer Screening

Historically, access to cervical cancer screening in Zambia, as in most resource-constrained nations, has been limited and only available to the affluent and/or overtly symptomatic. In 2005, we performed a pilot cervical cancer screening study of 150 women seeking HIV care and treatment at the University Teaching Hospital of Zambia. We found 33% of the study participants had Pap smear evidence of high grade cervical pre-cancer while 20% already had evidence of cancer. These findings, coupled with the previously described epidemiology of cervical cancer and HIV in Zambia, motivated us to establish early detection and treatment services for ALL Zambian women, targeting those receiving HIV care and treatment through PEPFAR (President’s Emergency Plan for AIDS Relief) - funded primary care sites in Zambia.

Started in January 2006, the CIDRZ Cervical Cancer Prevention Program is the first in any resource-constrained African nation to specifically target HIV-infected women. It is now operating in 14 clinics with plans to significantly expand throughout Zambia as funds become available. All early detection and treatment services are integrated into pre-existing government public health clinics and are free of charge.

Nurses take a digital photograph of the cervix which is used to aid them in diagnosis and to educate atients. The picture can be wirelessly transmitted to a gynecologist for mmediate distance-consultation.Complex cases are referred to the Gynecologic Cancer Prevention Unit at the University Teaching Hospital of Zambia, where they are further evaluated by gynecologists.

Outcomes

1. Over 11,000 women have been successfully screened and treated as of January 2008 Over 11,000 women have been successfully screened and treated as of January 2008

2. Approximate 50% of the women screened for cervical cancer are HIV-infected, 25% are HIV-negative and 25% are of unknown HIV status Approximate 50% of the women screened for cervical cancer are HIV-infected, 25% are HIV-negative and 25% are of unknown HIV status

3. Almost 40% of screened women have positive tests and require some form of treatment or evaluation Almost 40% of screened women have positive tests and require some form of treatment or evaluation

4. The program is safe, effective and highly acceptable by patients The program is safe, effective and highly acceptable by patients

References provided upon request

Groesbeck Parham, M.D.

Professor of Medicine University of Alabama

School of Medicine

Mulindi H. Mwanahamuntu, MH, MBBS, MMed

University Teaching Hospital of Zambia