Background and Context:Zambia has one of the World’s highest prevalence for both HIV (16% women of reproductive age) and cervical cancer (52.8/100,000 ASR) (GloboCan, Zambia Factsheet).Chlamydia trachomatis infection increases the risk of HPV acquisition or HPV persistence, and repeated CT infections increase the risk of CIN3+ among women with prevalent as well as persistent high-risk HPV infection (Jensen KE, et al). Point of care (POC) STI screening and same-day treatment was introduced, on a trial run, on the already existing integrated mobile HCT and Cervical cancer screening and early treatment (2⁰ prevention) program, with proven strengths of task shifting, telemedicine, and demand creation.
Aim: Secondary prevention of Cervical cancer by early treatment of asymptomatic common STIs
Strategy/Tactics:Zambia Defence Force Medical Services (DFMS), with support from PCI, trained personnel from the HCT and Cervical cancer screening team on the three STIs (RST, GC, and CT) SOPs and the integration thereof. Positive results would be treated immediately, with adequate partner notification call-up and treatment.
Programme/Policy Process:1,470 women (median age 35) were screened for Cervical cancer and HIV/STIs: Out of these, 119 (8%) VIA+ (including? Cervical cancer) 205 (14%) were positive for STIs [193(94%) asymptomatic, 12 (6%) symptomatic], 275(18.7%) HIV+. There was a high consent / test rates of 100%/100% for syphilis; 99.8%/100% HIV; 97.1%/92.7% cervical cancer; and, 97.4%/73.9% each, for GC and CT. Waiting time was not significantly changed by addition of the new tests.
Outcomes/What was learned:In a country with an absent routine medical check-up schedule, a population with poor health seeking behavior (‘what doesn’t hurt doesn’t need attention’), and the project’s results showing a high STI incidence of 14% with 94% asymptomatic for STI, the addition of POC STI screening and treatment in the routine Cervical cancer screening will be an essential tool for secondary prevention.