1. Integration of cervical cancer prevention services into an existing family planning program in Uganda
Dr. Kaggwa MN, PSI
November 2018, ICFP, Kigali, Rwanda

2. Outline Background Approach Method Results
Program implications/lessons

4. Cervical Cancer - Why do we need to act?
Caused by high risk HPV strains
Burden is growing and inequitable
569,000 new cases 311,00 deaths annually
85% of cases and deaths occur in LMICs
New graphicc added – the other one was blurry. Feel free to change graphic, it just needs to be clear and a good graphic.
If you use this graphic, you’d have to verbally tell the audience what it’s showing them. This is noted
You can make these points on this slide, as it’s a strong intro, and then say something like…
A lot of this is preventable and for the health economists among you, the intervention I will describe provides excellent value for money, compared to not acting or sticking only to traditional screening approaches (albeit if you say that, someone is bound to ask a question about cost and value for money!)
Heather added…
If you get in to cost and cost effectiveness, you can share that cervical cancer screening and early treatment is considered a WHO Best Buy. HPV testing has been shown to be more cost effective than other screening methods when high rates of coverage can be achieved and when treatment rates for HPV+ women are 80% or higher.
Additional talking points for this slide if required:
cervical cancer burden is growing – 2018 data released by WHO/Globocan show that rates are increasing. WHO predicts that these rates will increase to in the absence of national plans
85% of disease and mortality occurs in LIMICs, and most affected are those countries already heavily impacted by HIV/AIDS (see global map)
The good news: This cancer is preventable with HPV vaccine and early screening/treatment interventions in place

5. Background
Cervical cancer (CC) is a major cause of premature death and disability, despite being highly preventable.
LMICs account for 85% of all CC cases globally, largely due to a lack of CC prevention services.
In Uganda, Cervical cancer is the leading cause of female cancer deaths. In addition, 28% married women in Ugandan women have an unmet need for MC.
Strategies to deliver a comprehensive basket of SRHS to women across their life course is a shared priority among program implementers and policy makers.

6. Background
By integrating the right services in the right places, PSI is working to better meet women’s health needs across the life cycle and increase our impact.
Contraceptive prevalence rate was 20.7 in Uganda (DHS 2011); It has improved greatly to 47% in 2016 (DHS 2016)
Unmet need for Family planning is 28% (DHS 2016);
Cervical Cancer Screening coverage low
Theory: Successful integration of cervical cancer screening into existing FP programs can increase uptake of both services

7. FP consultations
30-49 years, same-day CC screening using visual inspection with acetic acid (VIA)
Lesions treated with cryotherapy subjected to eligibility if not referred
Cervical cancer screening/
treatment
Sensitization about other SRH services e.g. FP
FP methods and other SRH service offered
Category 1:
Category 2:
Approach
PSI  PACE, launched CC prevention services in through network of private sector clinics “ProFam”
ProFam clinics offer a package of SRH service including; family planning (FP) consultations
Population Services International, (PSI), through its local affiliate, the Programme for Accessible Health, Communication and Education (PACE) launched CC prevention services in 2012 through its national franchise network of private sector clinics. ProFam clinics offer a package of SRH services, including family planning (FP) consultations. Women presenting for FP consultations who meet WHO’s target age range, years, are offered same-day CC screening using visual inspection with acetic acid (VIA) and cryotherapy, as indicated. Conversely, women presenting for CC services are made aware of other SRH services offered.

8. Methodology
To identify temporal trends in service uptake once CC prevention services were integrated within the ProFam network
We conducted a multi-year review of services uptake among all female clients accessing FP and CC services within clinics offering these services in the network.
Reviewed all FP and CC service data between FP services data were disaggregated by contraceptive method & age for each year.

9. Results 214 ProFam clinics
Percentage of Clients that Received FP/Contraceptive + CC Services During a Clinic Visit
Results
214 ProFam clinics
A total of 306,318 women received a contraceptive method;
Of those, 145,291 (47%) also received CC screen and treat services
Between , a total of 214 ProFam clinics offered both CC and FP services.

10. Stratification of Clients by Type of Family Planning Method
Results
Highest proportion of CC service uptake was among women who opted for IUDs, followed by implants.
These findings were consistent across the 3- year period.
The median age category for women who chose;
Either tubal ligation or IUD : was years. short-term methods or implants was years.

11. Discussion
Integration of CC prevention services and FP services is both feasible and desirable among Ugandan women.
Integrated services are largely driven by women who chose either permanent methods or IUD provision as their contraceptive method of choice.
First, the program has been able to maintain consistent uptake for multiple services across several years.

12. Discussion
Integration of CC ‘screen and treat’ services is particularly convenient in this context, since it can performed as a combined procedure.
While concerns exist that these services may be inefficient since they target different age groups, these data highlight a consistency in CC screening uptake by method, offering providers an opportunity to tailor SRH services according to women’s needs and desires.
This trend is also important in light of recent evidence which suggests that IUD use may reduce cervical cancer risk.

13. These are two to three sentences that tell your audience:
Conclusion
These multi-year data highlight favorable temporal trends for integrated service delivery
Recent trends also suggest that IUD use may reduce cervical cancer
FP/SRH programs should consider the benefits of an integrated program in a resource poor setting
These are two to three sentences that tell your audience:
Where do we go from here?
How is our claim (and the evidence behind it) relevant for the wider community of practice?

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