One million women screened for cervical cancer in low-and middle-income countries

Geneva, 7 March 2023 – Over one million women in 14 low-and middle-income countries have been screened for cervical cancer through an integrated prevention program, delivered by country governments in collaboration with global health agency Unitaid, the Clinton Health Access Initiative (CHAI), and Expertise France as the lead of the SUCCESS project, in partnership with Jhpiego and the Union for International Cancer Control (UICC). Over 80 percent of women who have screened positive for cervical pre-cancer have received treatment.  

This is part of a broader effort to develop scalable models for cervical cancer prevention that is adapted to lower income settings across Africa, Asia, and Latin America where nine in ten deaths from cervical cancer occur.  

The program has seen countries train thousands of health workers and significantly expand the number of medical facilities offering life-saving screening and preventive treatment.  

The program is designed around a package of high performing and cost-effective screening, preventive treatment, and planning tools and delivery methods, including:

  • World Health Organization (WHO) tools to produce national costing plans for a prevention program using human papillomavirus (HPV) testing, which identifies the leading cause of cervical cancer and replaces a less accurate screening method based on visual inspection of the cervix. 
  • Introducing self-sampling methods for HPV testing, which circumvent the need for pelvic examinations–a promising technique to increase participation in screening programs. 
  • Supporting integrated patient monitoring tools, connected to national databases, across many program countries. 
  • Introducing portable thermal ablation devices, which provide a simpler and more affordable method of treating pre-cancerous cells on the cervix compared to traditional cryotherapy machines. 
  • Engaging and supporting civil society organizations to raise awareness within their communities of the services available, and in advocacy—essential for sustainable and long-term progress.

Additionally, the program is supporting development of artificial intelligence-based assessment tools–an emerging innovation with the potential to improve accuracy of visual screening methods.

Since October 2019, programs in Burkina Faso, Côte d’Ivoire, Guatemala, India, Kenya, Malawi, Nigeria, the Philippines, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe have been developing and demonstrating successful implementation of this package of care. With the program’s support, more than 250,000 women have been screened in Kenya, more than 190,000 women have been screened in India, and more than 200,000 women have been screened in Nigeria over the past three years.

By November 2022, program sites in half of these countries were achieving the World Health Organization’s (WHO) target to ensure 90 percent of women who screen positive for pre-cancerous lesions receive preventive treatment—seven years ahead of schedule, thus demonstrating effective models at scale that are ready to be replicated in other countries and contexts.  

According to WHO, approximately 600,000 new cases of cervical cancer are recorded each year, resulting in over 340,000 deaths. However, cervical cancer is highly preventable when women have access to early screening and preventive treatment. The risk of cancer is reduced, and health outcomes improved the earlier infection is diagnosed.  

Philippe Duneton, Executive Director of Unitaid comments: “With one million women reached so far, Unitaid is pleased to see that this package of effective and affordable technologies and delivery models is proving successful in fighting cervical cancer in low- and middle-income countries. We now call on governments and partners to urgently scale up these models of care and reduce the burden of cervical cancer in LMICs, where nearly all deaths from the disease occur.” 

As part of the program, Unitaid and CHAI negotiated substantial price reductions for HPV tests of approximately 40 percent to less than US$9 and achieved an approximate 45 percent reduction in the cost of thermal ablation devices. 

Joshua Chu, Executive Vice President, Vaccines and Non-Communicable Diseases, Clinton Health Access Initiative adds: “Reaching one million women screened for cervical cancer through the Unitaid-funded program is a major milestone, and we recognise the efforts of the Ministries of Health to prioritise resources to ensure women have an equal chance to live healthy and fulfilled lives. However, more needs to be done to rapidly expand these services, avert 65 million more deaths from this preventable and treatable disease over the next century, and ultimately eliminate cervical cancer as a public health threat.” 

Through its various outreach and education strategies, the SUCCESS project has been able to achieve a high level of acceptability of self-sampling in its four implementing countries. Indeed, nearly 88 percent of women screened used self-sampling.  

Eric Fleutelot, Technical Director, Major Pandemics Unit, Health Department, Expertise France mentions: “The devotion of the Ministries of Health with whom we collaborate, through cancer control programs, as well as HIV programs, demonstrates the interest of the implementation of these innovative solutions. For our efforts to be sustainable, and thus be able to reach several million women, we need to bring in more financial partners to this fight. The SUCCESS project has been pursuing various avenues to secure and expand funding streams, such as through other partners like L’Initiative and the Global Fund.” 

Dr. Bente Mikkelsen, WHO Director for Noncommunicable Diseases: “We applaud the 14 countries’ achievement in reaching over one million women with services to prevent cervical cancer. WHO is pleased to work with Unitaid and its partners, demonstrating that, with innovative collaboration, the 90-70-90 elimination targets are achievable. Together, we must build on the momentum and support countries to bring services to scale, until women everywhere have access to the dignified care they deserve.”

Banner photo: A nurse in Rwanda explains cervical cancer screening to one of the many women who are now accessing critical preventive services. © Unitaid

About the World Health Organization’s cervical cancer elimination strategy  

To eliminate cervical cancer as a public health problem, all countries must reach and maintain an incidence rate of below four per 100,000 women. This goal rests on achieving the following three targets by 2030, which align to WHO’s three strategic pillars:   

  • Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15  
  • Screening: 70% of women screened using a high-performance test by the age of 35 and again by 45  
  • Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed

 

About Unitaid’s cervical cancer programs in collaboration with CHAI and the SUCCESS project 

Unitaid has invested nearly US$70 million to advance an effective package of tools and delivery models to support secondary prevention of cervical cancer in low- and middle-income countries. The projects are currently working in partnership with the governments of 14 countries – through CHAI in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe, and through the SUCCESS project in Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The SUCCESS project is implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC). 

 

About Unitaid

Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.

 

About CHAI

The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low- and middle-income countries. We work with our partners to help strengthen the capabilities of governments and the private sector to create and sustain high-quality health systems.

 

About Expertise France

Expertise France is a public agency and the interministerial actor in international technical cooperation, subsidiary of the Agence française de développement Group (AFD Group). As the second largest agency in Europe, it designs and implements projects that sustainably strengthen public policies in developing and emerging countries. Governance, security, climate, health, education… It operates in key areas of development and contributes alongside its partners to the implementation of the Sustainable Development Goals (SDGs). For a world in common.

 

About Jhpiego 

Jhpiego, a global health non-profit and Johns Hopkins University affiliate, creates and delivers transformative health care solutions that save lives. For 50 years, Jhpiego has worked in partnership with 155 countries to build a strong health workforce and develop systems that improve health and transform the futures of women and their families. For the past three decades, Jhpiego has worked to eliminate cervical cancer in low and middle-income countries. Jhpiego’s approach mirrors the WHO Elimination Strategy goals, and begins with prevention through HPV vaccination, detection with HPV-DNA screening with a priority on primary and community settings, and early treatment for precancerous lesions. Through SUCCESS and in partnership with Expertise France and UICC, we have introduced this accessible, affordable, and achievable approach in the four project countries, Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines. 

 

About UICC 

The Union for International Cancer Control (UICC) is the largest and oldest international cancer-fighting organisation. Founded in Geneva in 1933, UICC has over 1,200 member organisations in 172 countries. It enjoys consultative status with the United Nations Economic and Social Council (ECOSOC) and has official relations with the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), the International Atomic Energy Agency (IAEA) and the United Nations Office on Drugs and Crime (UNODC). UICC has over 50 partners, including associations, companies and foundations committed to the fight against cancer. UICC is a founding member of the NCD Alliance, the McCabe Centre for Law & Cancer and the International Cancer Control Partnership (ICCP). UICC established the City Cancer Challenge Foundation in January 2019 and the Access to Oncology Medicines (ATOM) Coalition in 2022.

UICC’s mission is to both unite and support the cancer community in its efforts to reduce the global cancer burden, promote greater equity and ensure that cancer control remains a priority on the global health and development agenda. It pursues these goals by bringing together global leaders through innovative and far-reaching cancer-control events and initiatives, building capacities to meet regional needs and developing awareness campaigns. 

Media contact:

For more information and media requests:

Maggie Zander, Communications Officer, Unitaid

M: +41 79 593 17 74

zanderm@unitaid.who.int

 

Corina Milic, Acting Director of Communication, Clinton Health Access Initiative

cmilic@clintonhealthaccess.org    

World Cancer Day: The road to cervical cancer elimination

Unitaid and global health partners reach 90% treatment target for women screened with cervical cancer in multi-country pilots 

  • Unitaid-funded implementation programmes in Burkina Faso, Côte d’Ivoire, Malawi, Nigeria, Philippines, Rwanda and Senegal are reaching 90% treatment targets for women identified with pre-cancerous lesions just two years after launch of WHO cervical cancer elimination strategy – seven years ahead of schedule 
  • Cervical cancer is highly preventable, yet poorly adapted tools and ineffective screening have left women in low- and middle-income countries – where nine out of 10 deaths occur – without access to life-saving prevention  
  • Implemented by the Clinton Health Access Initiative (CHAI) or the SUCCESS consortium (Expertise France, Jhpiego and the Union for International Cancer Control), programmes in seven countries are advancing an effective model of care ready for broad and urgent scale-up  
  • More than 50% of the women reached through the programmes in the seven countries have been screened with an HPV test, progressing towards a second WHO target to reach 70% of women with high-performance screening
  • Pricing agreements secured through Unitaid investments have reduced costs for pre-cancer treatment devices by nearly 45% and HPV tests by nearly 40% and are widely available for global uptake 

Geneva – Global health agency Unitaid and its partners have developed and implemented a highly effective package of tools and strategies for cervical cancer prevention. Project sites in seven countries are already exceeding the WHO target to treat 90% of all women identified with pre-cancerous lesions by 2030, just two years after the launch of the WHO Cervical Cancer Elimination Strategy (17 November 2020). 

Funded by Unitaid and implemented in partnership with the Clinton Health Access Initiative (CHAI) and the SUCCESS consortium (Expertise France, Jhpiego and the Union for International Cancer Control), the programmes in Burkina Faso, Côte d’Ivoire, Malawi, Nigeria, Philippines, Rwanda and Senegal are demonstrating a life-saving cervical cancer prevention model poised for broader – and urgent scale-up. 

These models integrate a package of preventive care using high-performance HPV screening and portable devices for treating pre-cancerous lesions into existing health structures to increase coverage and awareness. Implemented widely, the models can achieve the WHO target for pre-cancer treatment and contribute to averting nearly 65 million deaths from cervical cancer over the next century. 

The programmes are also progressing towards a second WHO target to reach 70% of women with high-performing screening by age 35 and again by 45, with more than 50% of women screened within the Unitaid-supported programmes having received an HPV test. In addition, three in four women receiving HPV tests are opting for self-sampling, which circumvents pelvic examinations that can be a deterrent to screening, confirming this method’s promise to extend access to even more women.  

HPV testing replaces a far less accurate, subjective screening method based on visual inspection of the cervix in countries that already have solid diagnostic network capacity. Hand-held, battery powered thermal ablation devices replace heavy cryotherapy containers that require compressed gas. These devices allow for treatment of pre-cancerous lesions in primary health centers and reduce treatment time to one to two minutes, compared to 15.  

To facilitate uptake, pricing agreements secured by Unitaid and CHAI have reduced the cost of thermal ablation devices by nearly 45% and HPV tests by nearly 40%. However, field data from countries show that the overall cost of thermal ablation is nearly ten times less than cryotherapy per woman treated.   

Cervical cancer is highly preventable when women have access to early detection and treatment. However, in low- and middle-income countries where nine out of 10 cervical cancer deaths occur, progress has been held back by a lack of awareness and financing, as well as high costs, ineffective screening methods, and poorly adapted treatment devices.  

“Unitaid and partners have delivered the models and technologies to make cervical cancer elimination a reality,” said Dr Philippe Duneton, Executive Director of Unitaid. “Now it comes down to access for all women. We must see concerted urgent action from governments and partners to scale up these models and bring an end to cervical cancer for generations to come.” 

“On this second anniversary of WHO’s cervical cancer elimination strategy, we applaud all those who are helping to make innovative technologies accessible, so that women everywhere can enjoy the fundamental right to healthcare that we all deserve,” said Dr Princess Nothemba (Nono) Simelela, WHO Assistant Director-General for Strategic Priorities and Special Advisor to the Director-General. “Unitaid and its partners are making a very important contribution to our collective mission – I hope even more supporters will take inspiration from the early progress and join us in the effort to scale up services.”   

Unitaid is the largest funder of innovative tools to find and treat precancerous lesions in women living in low-resource settings with nearly US$70 million invested. Projects in 14 countries are developing models for cervical cancer prevention adapted to low- and middle-income countries’ needs. 

ADDITIONAL QUOTES 

“As the world marks the anniversary of WHO’s Cervical Cancer Elimination Strategy Launch, CHAI celebrates the incredible milestones achieved over the past three and a half years thanks to Unitaid funding. We are committed to working with governments to expand equitable access to lifesaving health services for women and provide affordable and effective tools to reach those most in need. This is crucial to accelerate our progress toward eliminating cervical cancer as a public health issue. We hope our success so far will inspire more countries and partners to implement programs to help protect the health of women and provide better access to crucial treatments.” – Joshua Chu, Executive Vice President, Vaccines and Non-Communicable Diseases, CHAI 

“The fight against cervical cancer is a fight against inequalities. Cervical cancer disproportionally affects women in limited-resources countries as well as women with disadvantaged social-economic status in high-income countries. Women living with HIV have a six-fold increased risk of developing cervical cancer compared to women without HIV. Despite being identified as an AIDS-defining disease in 1993, little has been done to address the need for cervical cancer prevention for women living with HIV. With Unitaid’s support, the SUCCESS project works on supporting governments and civil societies in lower- and middle-income countries to join forces of cancer and HIV national programs and communities. We focus on exploring people-centered and integrated interventions suitable for local contexts. Expertise France, through L’Initiative, is also contributing to this synergy by financing technical assistance, implementation, and operational research projects addressing HIV and HPV coinfections.” – Dr Lisa HUANG, SUCCESS Project Director, Expertise France 

“We are seeing incredible progress on introduction and adoption of new secondary prevention approaches since the launch of the WHO Elimination strategy. This innovations journey underscores that healthcare system thinking is critical to see increased gains towards the elimination targets, and see cervical cancer prevention integrated and financed into routine women’s health and HIV services, and ensure the necessary communications, training, supply chain, and laboratory systems to scale and sustain this progress. Jhpiego continues to support government partners, providers, and communities to increase women’s access to prevention and treatment, and is thrilled over the progress with self-sampling for HPV.” – Tracey Shissler, Implementation Director, SUCCESS, Jhpiego   

“The progress towards eliminating cervical cancer highlights what can be achieved in all income settings through effective financing, political will and on-the-ground expertise. In order to ensure that the gains made are secured for the long term, UICC will continue to work with and support its global network of member organisations and civil society more generally to fulfil their vital role in advocacy and hold governments to account.” – Dr Kirstie Graham, Director, Capacity Building, UICC 

NOTES FOR EDITORS 

Cervical cancer statistics:  

  • A woman dies every two minutes from cervical cancer  
  • Nine out of ten cervical cancer deaths worldwide occur in low- and middle-income countries  
  • Women living with HIV are six times as likely to develop cervical cancer  
  • For every 1 million women screened and treated, 200 to 300 cases of cervical cancer will be averted; for every 1 million women living with HIV screened and treated, several thousand cases of cervical cancer will be averted  
  • Achieving the WHO cervical cancer elimination targets by 2030 would result in over 62 million cervical cancer deaths averted by 2120 

WHO targets:  

To eliminate cervical cancer as a public health problem, all countries must reach and maintain an incidence rate of below four per 100,000 women. Achieving that goal rests on three key pillars and their corresponding targets:  

  • Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15 
  • Screening: 70% of women screened using a high-performance test by the age of 35 and again by 45 
  • Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed 

About Unitaid’s cervical cancer programmes  

Unitaid has invested nearly US$70 million to advance an effective package of tools and delivery models to support secondary prevention of cervical cancer in low- and middle-income countries. The projects are currently working in partnership with the governments of 14 countries – through CHAI in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, South Africa, Uganda, Zambia, and Zimbabwe, and through the SUCCESS project in Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The SUCCESS project is implemented by Expertise France, Jhpiego, and the Union for International Cancer Control (UICC).

Media contacts

Hervé Verhoosel, Spokesperson Unitaid, mobile/whatsapp +33 6 22 59 73 54, verhooselh@unitaid.who.int  

Corina Milic, CHAI, cmilic@clintonhealthaccess.org 

Portable thermal ablation devices allow more women to access lifesaving cervical cancer prevention in countries where the majority of deaths occur  

Geneva – Global health agency Unitaid and the Clinton Health Access Initiative (CHAI) today released results from a two-year project to increase access to lifesaving treatment for cervical precancer in low- and middle-income countries.  

The white paper published today shows that thermal ablation, a portable and effective tool for treating cervical precancer, has the potential to substantially expand access in low- and middle-income countries where almost 90 percent of deaths occur. Although cervical cancer is preventable and curable, it continues to be a leading cause of cancer-related deaths for women globally. Each year 300,000 women die from the disease. Women living with HIV are at particularly high risk of illness and death.  

In response to the World Health Organization’s (WHO) call for the global elimination of cervical cancer, Unitaid has invested nearly US$70 million to increase access to life-saving screening and treatment tools that have shown to be better adapted for use in resource-limited settings than the current standard of care.  

Thermal ablation devices are easy to use and maintain and can be run on battery power, allowing them to be used at primary health facilities and in hard-to-reach settings. Following training, the devices can be operated by a broad range of health care workers, expanding the pool of staff who can safely offer treatment of precancerous lesions, which is critical in preventing the progression to cancer.  

Furthermore, with recently announced ‘access’ prices for thermal ablation devices, this treatment method is significantly more affordable than cryotherapy—the most common method of treatment in low-and middle-income countries.  

The devices are now available at the access prices through UNICEF Supply Division, a major new route for procurement, as well as directly through the manufacturers. This allows programs to affordably expand access, enabling more women to receive treatment following a positive screening result, saving lives, and helping countries to reach the goal of cervical cancer elimination. However, additional funding to support broader scale up of these devices is urgently needed so women everywhere can benefit.  

The outcomes are the result of a Unitaid-funded project led by CHAI in collaboration with governments in India, Kenya, Malawi, Nigeria, Rwanda, Senegal, Uganda, Zambia, and Zimbabwe to support procurement and roll out of thermal ablation devices, develop clinical guidelines, and train health workers on device usage. Across the countries, the project found that thermal ablation improved equitable access to treatment because it can be used quickly, safely, and effectively, even in the most remote clinics, reducing the number of patients lost to follow-up and reaching more women. Rapid treatment following diagnosis of cervical precancer is critical to cancer prevention.  

“When women have access to early screening and treatment, cervical cancer is one of the most preventable cancers,” said Dr Philippe Duneton, Executive Director of Unitaid. “With more affordable, portable devices that can be used in local health centers, we have the tools and the model that can deliver cervical cancer elimination. Now we need governments, with national and international partners to step in and step up to ensure this work benefits all women, everywhere.” 

CHAI Executive Vice President for Vaccines and Non-Communicable Diseases, Joshua Chu, stated, “This innovative project has shown that thermal ablation can be effectively and affordably rolled out across our partner countries. Most importantly, it is reaching more women with lifesaving treatment which will save lives and bring us one step closer to cervical cancer elimination.” 

Increased portability enables governments to offer treatment for precancerous lesions flexibly within either campaign-style screening models or at defined health facilities, leveraging community health services. Partner countries also reported that thermal ablation is easier to procure than cryotherapy as it requires coordination only with dedicated suppliers at standardized prices, rather than working with both device manufacturers and suppliers of gas cylinders (required for cryotherapy operation). Importantly, partner countries expressed that thermal ablation can be rolled out for a fraction of the cost of cryotherapy.  

The white paper shared today will help inform scale up in partner countries and roll out to additional countries.  

You can read more about the project findings here: 

Media contacts:

For more information and media requests:

Regan Lachapelle, Communications Director, CHAI, rlachapelle@clintonhealthaccess.org 

Maggie Zander, Communications Officer, +41 79 593 17 74, zanderm@unitaid.who.int 

Unitaid supports the WHO’s cervical cancer elimination strategy launch

Geneva – Unitaid is delighted to give its support to today’s launch of the WHO’s Global Strategy to Accelerate the Elimination of Cervical Cancer – the first time the world has ever committed to eliminating a cancer.

Unitaid’s chair Marisol Touraine has come together with WHO Director General Dr Tedros, Dr Princess Nono Simelela, the First Ladies of Rwanda and South Africa and many others to get behind this ambitious, life-saving strategy.

The facts are sobering. Cervical cancer is the fourth most common cancer affecting women, killing more than 300,000 every year. Nine out of ten women who die from cervical cancer are from low- and middle-income countries, and women living with HIV are six times more likely to develop cervical cancer.

When the WHO first made a rallying call to action in 2018, Unitaid mobilised quickly to invest more than US$60 million with the clear goal of making life-changing improvements in the screening and treatment of women with cervical cancer – particularly targeting those in high-burden countries who do not have access to vaccination.

Unitaid is now the largest funder of innovative tools to find and treat precancerous lesions in women living in low-resource settings. These investments have laid a firm foundation for the elimination strategy, and Unitaid remains on-target to reach one million women within three years, with an estimated 100,000 additional lives saved over eight years.

Our partnerships with CHAI, Expertise France, Jhpiego and UICC focus on introducing innovation and making it accessible and affordable. Many of the successful techniques for reducing cervical cancer in high-income countries are difficult to transfer over to low-and-middle income countries, so Unitaid’s fresh and targeted approach has transformational potential.

We have already made significant progress towards our ambitious goal of delivering screening and treatment for less than US$1 per woman. Thermal Ablation devices are now available for less than US$900, representing an average price reduction of 50%.

With these more affordable devices, treating one woman will become not only faster (1-2 minutes versus 15 minutes) but also easier, thanks to the use of a battery-operated handheld device, rather than a heavy container that requires compressed gas. Overall, it is almost ten times cheaper than cryotherapy, the previously-used treatment.

Our investments have also resulted in HPV testing prices coming down by a third, which will give more women access to screening and help embed this in national government’s health systems in a sustainable way.

Chair of Unitaid’s Executive Board, Marisol Touraine said: “No woman or girl – irrespective of where they are born or where they live – should fall prey to cervical cancer. We cannot see cervical cancer as a death sentence because it is one of the most preventable and treatable cancers. I call on all countries, organisations and partners to make our objectives a reality by fully engaging to concretely implement these solutions for the most vulnerable countries.”

Our projects:

Media contact: Charlotte Baker | +44 7904 460 181 | bakerc@unitaid.who.int

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