Context

Specifically, Unitaid seeks to accelerate access and scale use of optimal tools for cervical cancer secondary prevention in low- and middle-income countries.

The objective of this call for proposals is to identify projects that can address access barriers, catalyse the market for, and support adoption of improved tools for managing the disease at the pre-cancer stage, thereby reducing the increasing death toll due to cervical cancer in low and middle-income countries (LMICs) in general, and in particular in HIV-coinfected women. By making the global and country response to early detection of cervical cancer more efficient, Unitaid will be contributing to the elimination of cervical cancer as a public health problem, as called upon by WHO in this World Health Assembly, May 2018.

Strategies that identify women at risk of cervical cancer and provide them early detection and treatment at the pre-cancer stage have dramatically decreased incidence and mortality of cervical cancer in high-income countries. There is an urgent need to change the screening paradigm in LMICs to achieve broader impact through equitable access to this life saving intervention. Women living with HIV are particularly vulnerable, with HPV co-infection progressing more frequently and rapidly to cervical cancer.

As prophylactic HPV vaccination is yet to be introduced and scaled up in most LMICs, access to efficient screen-and-treat programs is key to reducing mortality due to cervical cancer now, and will remain so in the coming years.

A number of tools are available that are recommended as cost-effective and therefore priority interventions for LMICs. However, emerging tools, such as HPV molecular tests and alternative treatment devices, are out of reach for most populations in need, with severe access barriers on both the supply and demand side. Such barriers mean that healthcare workers in LMICs rely on the use of substandard tools and strategies for management of pre-cancer and prevention of cancer-related mortality.

Background

Cervical cancer is the leading cause of cancer deaths among women in LMICs. Over a quarter of a million women die of cervical cancer each year, with 90% of the deaths occurring in LMICs. The disease distribution is notably overlapping with that of HIV infection. Cervical cancer in HIV-infected women occurs 4 to 5 times more frequently than in HIV-negative women. Once infected with HPV, they are more likely to develop pre-invasive lesions that quickly progress into invasive, life-threatening cervical cancer if untreated.

Following HIV diagnosis, HPV screening is recommended every year for HIV-positive girls and women^[1].  However, only 5% of women are screened for HPV in LMICs. Current screening and treatment tools available in resource-limited settings are affected by severe constraints including low sensitivity and efficacy, lack of linkage to care following diagnosis and loss to follow-up, logistics constraints and lack of adequate human resources to effectively deploy these tools at scale.

Innovative tools are on the horizon, however, that could address one or more of these challenges and make possible accurate and safe screening and treatment of women in the same visit, leading to efficiencies both in terms of resources and public health outcomes (mortality). In tandem  with the HPV vaccine scale-up, these new generation tools make the elimination of cervical cancer possible.

A number of issues must be addressed for these innovations to be introduced with a robust evidence-base as a foundation for scale up of early detection to national population-based programmes in LMICs. Even in countries where there is strong political support to scale-up cervical cancer services, emerging tools remain largely unaffordable, restricting the ability of countries and funders to procure. Furthermore, limited demand and regulatory hurdles need to be addressed in order to create and sustain a market. Understanding the most effective approach for sustainable delivery of the new solutions within existing programs may also be required.

Call Scope

Under this call, Unitaid is soliciting proposals for the following interventions with a view to advancing innovative cervical cancer screening and treatment tools, enabling the paradigm change for screening and treatment programs in LMICs:

• Catalyzing a market for optimal products for cervical cancer screening and treatment in LMICs by addressing access barriers (market entry, affordability) for the most promising new technologies (molecular tests, other new tests and self-collector devices, point-of-care (POC) treatment devices);

• Supporting introduction of these products in selected early-adopter countries through integrated approaches, and identifying the most effective delivery channels to support future scale-up and maximize impact and value-for-money.

Implementation in countries will be catalytic in nature and time-bound, and transition to longer-term donor and/or domestic funding sources should be secured. Applicants are encouraged to consider settings where control of cervical cancer is a priority, and for which the enabling environment and the programmatic support exists. 

Proposals submitted should clearly demonstrate the fit with the objectives set out above, the expected impact and value for money as well as the complementarity and added value to similar projects in this area.

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^[1] World Health Organization (WHO). Comprehensive cervical cancer control: a guide to essential practice. Second edition. Geneva: WHO; 2014.

Process for proposal submission

When developing a proposal, please note the following resources:

• Answers to frequently asked questions relevant to proposal development (this document is regularly updated), please [click here PDF, 310 Ko];

Unitaid works through market-based interventions to achieve global market and public health impact. Proposals should clearly demonstrate the use of innovative and sustainable approaches. Demonstrated articulation with national programmes or other scale-up partners will therefore be key.

Topics which are out of scope for this Call include: proposals for early research projects and small-scale demonstration projects.

Applicants should be clear about the underlying assumptions made in their proposed approach, and should highlight any major risks or other factors that may affect the delivery of results. Finally, proposals are expected to outline a lean, concrete and clear pathway to results and impact.

The proposed implementing agency needs to demonstrate capacity/prior experience implementing projects of this nature, including engaging with civil society groups.

All proposals received will be considered, but Unitaid reserves the right to not fund all the areas outlined in this call. Funding may be allocated to more than one successful proponent.

Important dates

N.B. A proposal is considered submitted only once you receive an e-mail message of confirmation of receipt from Unitaid.

Proposals, including all annexes, should be submitted electronically to proposalsUnitaid@who.int. A full proposal consists of the following documents:

• Proposal form [template DOC, 104 KB]
• Annex 1: Log frame [template XLS, 50 KB]
• Annex 2: Timeline GANTT chart [template XLS, 35 KB]
• Annex 3: Budget details [template XLS, 23 KB]
• Annex 4: Organizational details and CVs of key team members [no template]
• Annex 5: Support Letters (not mandatory) [no template]
• Annex 6: Declaration of relevant interest [no template]
• Annex 7: Applicable ethics, anti-discrimination and environmental policies [no template]
• Annex 8: Declaration regarding tobacco and arms entities [no template]
• Guidance on Impact Assessment [PDF, 450 KB]
• Financial Guidelines for Unitaid Grantees [PDF, 1,2 MB]

Please note that our email system accepts messages up to 8 MB in size. For submissions exceeding this size, please consider splitting attachments in several messages.

Your proposal and potential queries receive personal attention: submitting your application at least a day before the deadline allows providing feedback on its completeness. You will receive answers to your queries at any one stage of the application review process. Please send your queries to Grant Application Manager at proposalsUnitaid@who.int

You will find further guidance in the Unitaid proposal process document [PDF, 100 KB].

Webinar on Unitaid’s Cervical Cancer Call for Proposals:
Play recording (48 min)