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Most women who die from cervical cancer, particularly in developing countries, are in the prime of their life. They may be raising children, caring for their family, and contributing to the social and economic life of their town or village. Their death is both a personal tragedy, and a sad and unnecessary loss to their family and their community. Unnecessary, because there is compelling evidence, as this Guide makes clear, that cervical cancer is one of the most preventable and treatable forms of cancer, as long as it is detected early and managed effectively. Unfortunately, the majority of women in developing countries still do not have access to cervical cancer prevention programmes. The consequence is that, often, cervical cancer is not detected until it is too late to be cured. An urgent effort is required if this situation is to be corrected. This Guide is intended to help those responsible for providing services aimed at reducing the burden posed by cervical cancer for women, communities and health systems. It focuses on the knowledge and skills needed by health care providers, at different levels of care.
The World Health Organization (WHO) announced an ambitious call for global cervical cancer elimination within the next century. More than 80% of cervical cancers occur in low-and-middle-income countries (LMICs), where the age-standardized mortality rates are six-times higher than in high-income countries. The goal of this dissertation is to outline a roadmap toward cervical cancer elimination in LMICs and evaluate a community-based HPV self-sampling program in Peru via micro-costing and mixed-method study of empowerment. In the first aim, we conduct a scoping review to synthesize evidence-based primary and secondary prevention strategies for cervical cancer and highlight research gaps and priorities. We find that effective prevention methods include HPV vaccination, screening using visual inspection and HPV testing and thermocoagulation, and discuss implementation challenges in LMICs. Aims 2 and 3 are nested within a community-based HPV self-sampling social entrepreneurship in Peru called the Hope Project, where volunteer women (Hope Ladies) from socioeconomically disadvantaged peri-urban area of Lima sell HPV self-sampling kits in their communities to increase cervical cancer screening coverage. In Aim 2, we conduct a micro-costing analysis from the program perspective to determine the unit costs of: (1) recruitment and training of Hope Ladies, (2) Hope Ladies distributing HPV self-sampling kits (careHPV), and (3) Hope Ladies linking screened women with appropriate follow-up care. We find that community-based HPV self-sampling appears to be a feasible way to improve cervical cancer screening in Peru. In Aim 3, we evaluate the Hope Ladies' individual and collective relational and financial empowerment after participating in the Hope Project. We use deductive content analysis and surveys informed by empowerment frameworks (e.g., Kabeer's conceptual model) to triangulate our qualitative and quantitative findings. We develop an implementation-science informed causal pathway for the Hope Project, where the Hope Ladies' financial/relational empowerment function as the mechanism of action for this intervention and articulate the pre-conditions necessary to increase the screening coverage. Finally, we conclude that cervical cancer elimination in LMICs would require intersectoral collaboration to increase access to and coverage of evidence-based strategies. We call for implementation, scale-up and economic and programmatic evaluation of community-based HPV self-sampling in LMICs.
Cervical Cancer is the fourth most common cancer among women, worldwide. It accounts for 600,000 new cases per year, and 340,000 deaths globally (WHO 2020 data). It causes a lot of maladies and suffering for women, in the age group of 30,Äì60 years, especially in the poor community of developing countries. Cervical cancer is a great public health problem and is a cause of grave concern for the health system in Low-Middle-Income Countries,ÄîLMIC. But cervical cancer is amenable for early detection and successful treatment of precancer stages. Human Papilloma Virus,ÄîHPV vaccines offer a high level of primordial prevention, against cervical cancer. Therefore, the World Health Organization, in 2018, has called for ,ÄúElimination of Cervical Cancer by 2030.,Äù The objective is to reduce the incidence rate of cervical cancer to below 4/100,000, by the year 2030. This leads to many ,ÄúNeo Challenges,Äù and also opens the door for ,ÄúNext Gen Solutions,Äù. The author, with vast experiences in his Cervical Cancer Screening Projects of IARC/ WHO, at Tamil Nadu, India, during 2000,Äì2007, advocates a strategy called ,ÄúTIT for TAT,ÄîThe Community Competency model of Raj¬©.,Äù.
Cancer Care: Assuring Quality to Improve Survival surveys the policy trends in cancer care over recent years and looks at survival rates to identify the why some countries are doing better than others.
Sixth edition of the hugely successful, internationally recognised textbook on global public health and epidemiology, with 3 volumes comprehensively covering the scope, methods, and practice of the discipline
The rationale and purpose of the strategy: Despite being a preventable and curable disease, cervical cancer is responsible for a large burden of suffering in women around the world, especially in low-and middle income countries. To uphold the right to health for adolescent girls and women, it is important that disparities in access to high-quality health services are addressed. In 2020, the World Health Organization (WHO) set a goal to eliminate cervical cancer as a public health problem globally by 2120 (1). To reach this goal, WHO's Member States should strive to meet the following interim scale-up targets by 2030: 90% of girls are fully vaccinated with human papillomavirus (HPV) vaccine by 15 years of age; 70% of women are screened using a high-performance test by 35 years of age and again by 45 years of age;90% of women with pre-cancer are treated, and 90% of women with invasive cancer are managed.
In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
"This document is intended for use by national immunization programme managers and immunization partners to inform the policy discussions and operational aspects for the introduction of HPV vaccine into national immunization programmes and to provide upto-date references on the global policy, as well as the technical and strategic issues related to the introduction of HPV vaccine."--Publisher's description.