Background and Context:
Cervical cancer is one of the most preventable cancers, and yet it is still a major killer of women in most low-resource countries. There are now feasible and appropriate screening methods to identify women in their 30s and 40s with the precancerous lesions that can lead to cervical cancer if left untreated. Many of the critical elements are now in place, with new WHO guidelines delineating the options for screening, validated training curricula, and updated data on disease burden. A major rate-limiting step is getting affordable treatment for precancer to women when and where they need it.
PATH is conducting a multi-pronged approach to determine and address the underlying causes of the treatment bottleneck.
We identified three major factors affecting the availability of treatment (equipment, supplies, training) and two affecting treatment utilization (access to screening, costs to women in terms of fees and travel). This analysis led us to focus on three aspects that could potentially address several of these root causes: driving down the cost of equipment, new technology options, and better ways to deploy the available treatment methods.
We have conducted clinical and operational studies to evaluate alternative treatment technologies like cold coagulation and CryoPen (a new cryotherapy device that does not require external gas), and we developed a model to simulate various scenarios of deployment of treatment methods (static and/or mobile, placement at different levels of the health system, combinations of gas and gas-free devices) to understand the impact on treatment coverage.
Outcomes/What was learned:
Careful consideration of the characteristics of available treatment options and their smart deployment, taking into account population density and screening coverage, can help countries scale up their cervical cancer secondary prevention programs and ensure that precancer treatment is delivered in the most efficient and affordable way possible.