Comprehensive Cervical Cancer Prevention in Tanzania
The natural history of Human papillomavirus (HPV) in sub-Saharan Africa is not yet fully understood and information about how HIV together with other risk factors interacts with HPV acquisition and HPV persistence/clearance is warranted. Additionally, concern prevails about the quality of cervical cancer preventive strategies in sub-Saharan Africa.
Against this background the project aims to provide a better understanding of the natural history of HPV with a view to HIV status, measure the impact of a novel screening method based on care HPV testing and assess how continuity of care among women who are tested HPV positive can be improved. The study will be linked up with the existing cervical cancer screening program at Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Centre (KCMC); and will include 4000 women who are attending screening service or HIV care and treatment. HPV acquisition and persistence/clearance patterns as well as the absolute risk of severe cervical precancerous lesions will be determined through a follow up study lasting 28 months. The test performance of careHPV testing, liquid-based cytology and VIA will be described and the operating characteristics of the three screening methods will be assessed according to HIV status. Finally, the impact of a mobile phone intervention and a patient navigation model will be assessed and compared according to the proportion of HPV positive women who return for follow-up examinations. Additionally, the project will implement a research capacity building component focusing on transfer of knowledge and technology.
Midterm report 2017:
4063 women were recruited at ORCI and KCMC. Questionnaire interviews as well as collection of cervical samples for care HPV testing, ThinPrep and VIA was done. 75.0% (n = 3039) of recruited women were seen during 1st follow-up (14 months) for re-assessment. HIV status of the women was obtained by HIV screening. A total of 4418 samples were tested in Denmark and Germany. Additional 2684 samples will be shipped to Germany for HPV analysis in August 2018. A total of 429 women had their cervical samples also collected using self-sampling techniques. The protocol of the intervention for attendance to the screening clinics has been published in a peer-reviewed journal. A mobile phone sms system was developed and used to send formatted sms to 350 randomly selected HPV positive women to remind them to attend follow-up clinic. The other group (n = 350) did not receive formatted sms. Qualitative data on barriers for attendance to follow-up clinic has been collected. Data analysis is ongoing.