Community-based management of cervical cancer is usually done during mass campaigns such as Pink October. What is the CARES programme and what is its contribution to cervical cancer prevention in Casamance and Guinea Bissau?
Cervical cancer screening services are usually offered during the month of October each year, which is dedicated to cervical cancer screening. Enda Santé, aware of the high demand and the high prevalence of women with HPV in certain target areas, has set up a system for the early management of women with suspected cervixes through the CARES programme. Several training and orientation sessions on the three screening techniques have been organised for providers, particularly midwives at the sites, to ensure better care. Prevention remains a key element in our strategy. In addition to training, the CARES programme, with the support of its partners, has supported certain health facilities with medical and surgical equipment such as cryotherapy and cervical conisation machines in Ziguinchor and Bissau.
The programme shifts the service offer from the health structures to the populations, by applying free care. What is the added value of this strategy?
Regular distribution of inputs is done at the health posts, which are the first level of access to care. Other screening techniques such as Pap smears and HPV testing were not available throughout Casamance. All smear slides for reading and samples for analysis by GeneXpert were sent to Dakar, resulting in additional costs that patients were not always able to pay. In response to this situation, the CARES programme is working to provide free and systematic screening to all women presenting at a site who meet the eligibility criteria for the service. This approach also takes into account women living with HIV who are the most vulnerable to exposure to the papilloma virus. Moreover, the data collected to date show that the prevalence is higher among this target group than among women in the general population; hence the importance of integrating HPV (Human Papilloma Virus) screening into the health care offer at all levels of the health pyramid.
How is referral and monitoring done at the health facility level?
All women screened and presenting a suspicious cervix at VIA/L or whose slides and HPV tests come back positive are referred to the hospital facilities. A second confirmation of the suspicion is made by a gynaecologist in order to make a diagnosis. The implementation of all these elements has made it possible to detect thousands of women and to treat rapidly all the cervixes presenting precancerous lesions, to ensure follow-up by gynaecologists and to operate free of charge on some of those eligible for surgery.
What are the challenges of the programme in a covid-19 context?
It is the continuity of care services. COVID-19 has had a significant impact on the follow-up of cases, resulting in shortages of medical inputs and consumables, non-attendance of facilities by women, which slows down the strategy, and women who are scheduled for follow-up visits are lost to follow-up. Awareness-raising is at the heart of the CARES programme strategy, hence the involvement of women's associations and community leaders, whose messages focus on the importance of early detection at the facility level. Midwives and gynaecologists continue to ensure the continuity of care services despite the difficult context.
Enda Health, March 2021.