Integrating cervical cancer screening and prevention treatment with voluntary family planning in Mozambique (038)

Abstract

<b>Objectives:</b> Mozambique has cervical cancer incidence and mortality rates of 50.2 and 38.7 per 100,000 women, respectively. These high rates are due in part to a lack of access to cervical cancer screening and few medical providers skilled in the treatment of women with preinvasive cervical disease. The objective of this study was to develop, implement and test models integrating cervical cancer screening and prevention treatment with voluntary family planning programs using strategies to optimize the uptake and health impact of both services. <b>Methods:</b> Women aged 30 to 49 in Maputo City and Gaza Province, Mozambique, were prospectively enrolled in the study. Women were offered cervical cancer screening and/or voluntary family planning services as appropriate. Women were screened for high-risk human papillomavirus (HPV) DNA using the GeneXpert® (Cepheid Inc, Sunnyvale, CA, USA) platform. Participants were offered self-collection or provider collection of cervicovaginal samples. HPV-positive women underwent a pelvic examination by a nurse and visual assessment for treatment using visual inspection with acetic acid to determine eligibility for ablation. Prior to treatment, a photograph of the cervix was taken for quality assurance. Patients with lesions eligible for ablation underwent thermal ablation (87%) or cryotherapy (13%). If ineligible, women were referred to a gynecologist for evaluation and excisional treatment as appropriate. Local nurses and doctors were trained in cervical cancer screening and treatment of pre-invasive disease. Continuing education sessions were held weekly. Surveys were conducted to evaluate the integration of cervical cancer screening and family planning services, and these results will be reported separately. <b>Results:</b> From January 2020 to July 2021, 4,344 women were enrolled and screened with HPV testing. The median age of participants was 38 years. Among the participants, 45.7% of women were living with HIV (WLWH). The HPV positivity rate was 34.0% overall and 43.6% in WLWH. A total of 96% of the patients chose self-collection of HPV testing. Of the 1,477 HPV-positive women, 87.8% had been evaluated and treated. Treatments included ablation (<i>n</i>=1193, 80.8%), LEEP (<i>n</i>=84, 5.7%) or cold-knife-conization (<i>n</i>=4, 0.3%). Fifteen (1.0%) women were diagnosed with invasive cancer and navigated to gynecologic oncology treatment, whereas 12.2% were lost to follow-up. <b>Conclusions:</b> Preliminarily results indicate it is feasible to screen women for cervical cancer with primary HPV testing using self-collected samples in Mozambique. Almost 90% of screen-positive patients completed follow-up treatment. This study is ongoing, supporting a comprehensive approach to improve screening methods and uptake through integration with voluntary family planning, to test the feasibility of HPV testing and self-collection, and to improve provider education and skills through regular training.