By Nompumelelo Ntshangase (HST CCPAC Project Manager)
October is known as Breast Cancer Awareness Month. Equally important, September is Cervical Cancer Awareness Month.
In support of the World Health Organization (WHO) 90-70-90 strategic goals for elimination of cervical cancer by 2030, Health Systems Trust (HST) is conducting the Cervical Cancer Prevention, Access and Control (CCPAC) Project, which is the first of its kind for HST.
Funded by Bristol Myers Squibb Foundation, the CCPAC project is implemented through a consortium of implementers and operational researchers comprising HST, the Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU) of the University of KwaZulu-Natal (UKZN), Genius Quality (GQ), and the Zululand Department of Health (ZDoH).
The project aims to address the challenge of high cervical cancer incidence and mortality, and focuses on education and awareness, improving access to early screening, diagnosis, treatment and palliative services for cervical cancer in the Zululand district in KwaZulu-Natal. Through community-informed, evidence-based interventions; building on and harnessing existing resources; community and stakeholder involvement; strengthening health system structures; healthcare worker capacity-building; and integration with existing Primary Health Care (PHC) services, the project aims to support the sustainability of these multi-pronged interventions beyond the programme's lifespan of three years, i.e. from 2022 to 2024.
Zululand District is largely a rural community, with over 100 patients diagnosed with cervical cancer every year. However, there are no facilities for cancer treatment in this district. Patients who are diagnosed with cervical cancer have to travel long distances, as far as Empangeni or Durban, to access treatment and care. Prevention therefore becomes very important for this community.
The human papillomavirus (HPV) causes the majority of cervical cancer cases. Most women who have a strong immune system are able to recover from this sexually transmitted infection. Those with a compromised immune system, especially people living with HIV (PLHIV), may not be able to recover from HPV so easily, resulting in persistence of this virus causing cancerous changes in the cervix.
Cervical cancer is unique in that it has a clearly defined pre-cancerous phase, hence the importance of doing a Pap smear to identify these abnormal cells early and treat them before they become cancerous and spread. Despite the education and availability of free Pap smear services at PHC level, women are still presenting at late stages of this preventable cancer.
During this month, most awareness campaigns are focused on educating the public on strategies to prevent cervical cancer. As part of this campaign, women are encouraged to be screened with a Pap smear at their local health facilities. The CCPAC Mobile Clinic Team also conducts Pap smear screening in hard-to-reach locations in Zululand, and this service has enabled more than 2 000 women to be screened for cervical cancer within their communities. This mobile clinic brings hope to these rural communities, as is evidenced by the overall positive response and reception of this service in the community.
The CCPAC project has partnered with two community-based organisations to run awareness campaigns and to educate the communities on cervical cancer prevention. Education on safe sex practices, including delayed sexual debut, which delays exposure to HPV and HIV, is important. Early sexually debut and multiple sexual partners have been identified as a risk factor for cervical cancer.
The DoH, through its School Health Programme, is running a campaign to promote HPV vaccination among young girls to reduce their risk of contracting cervical cancer. In support of this initiative and in collaboration with the DoH, HST is also educating and encouraging mothers to have their young daughters vaccinated.
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