BACKGROUND: Cervical Cancer Prevention (CECAP) is a priority intervention as part of comprehensive HIV care for women living with HIV (WLHIV). There was low uptake of CECAP services in Tanzania’s Mwanza region in the first quarter of fiscal year 2022 (FY22), with 5% achievement of the annual programmatic target of screening 26,618 WLHIV (33% of women on ART) for precancerous cervical lesions. The initial poor performance was due to low service coverage, inadequate supplies, cryotherapy machine breakdown and scale up of 6 multi-months dispensing (6 MMD) of antiretroviral therapy (ART), which reduced WHLIV’s clinic appointment frequency. We describe here progress in scaling up CEPAP services in Mwanza.
DESCRIPTION: Between January and March 2022, facilities offering CECAP services were scaled up from 29 to 54. In addition, 97 facilities were added as outreach sites following onsite mentorship and provision of technical support by trained staff. Services were integrated with community ART refill through a mobile clinic to reach WLHIV who missed services, including those with 6 MMD of ART. Biomedical engineers were engaged to conduct corrective and preventive maintenance of cryotherapy machines and monitoring and timely delivery of CECAP supplies was done. We analyzed routine program data to illustrate trends in cervical cancer screening and treatment and how they proportionally correspond to the pre-set targets.
LESSONS LEARNED: WLHIV screened for cervical cancer increased from 1,294 in the first quarter of FY22 to 10,188 in the second quarter. By end of FY22, 25,701 WLHIV were screened, corresponding to 97% of the annual target; 65% of WLHIV were screened at outreach sites. Among WLHIV screened, 753 (3%) were found to have precancerous cervical lesions and 743 (99%) were linked to treatment with 92% completing treatment in the same visit. Out of 25,701 WLHIV screened, 103 (0.4%) were suspected to have cancer and were referred for further diagnosis.
CONCLUSIONS: The target for cervical cancer screening was almost achieved (97%) with 99% linkage to treatment following a combination of enhanced service delivery. The findings demonstrate that it is feasible to make substantial improvements in the uptake of CECAP services by implementing approaches to increase programmatic reach and quality.