In an effort to combat the high incidence of cervical cancer, Zambia has been at the forefront of implementing innovative screening methods. With the country ranking third globally in terms of cervical cancer burden, reporting an incidence rate of 65.5 per 100,000 women and a mortality rate of 43.4 per 100,000 women in 2020, the urgency to address this health crisis cannot be overstated. Cervical cancer represents approximately 23% of all new cancer cases among Zambian women, predominantly affecting those aged between 40 to 49 years. Despite its preventability and treatability, the challenge remains substantial.
Since 2006, Zambia has been proactive in its approach to cervical cancer screening, initially adopting visual inspection with acetic acid (VIA) as the cornerstone of its screening program. This initiative was strategically integrated into the HIV program, recognizing the heightened risk of cervical cancer among women living with HIV. Over the years, this initiative has successfully screened more than 1.5 million women. However, screening coverage at the population level has hovered around 26%, indicating the need for enhanced screening strategies.
In a significant stride towards improving cervical cancer screening, Zambia embarked on a pilot project in 2019 to introduce human papillomavirus (HPV) testing. Given that persistent infection with high-risk HPV types is the primary cause of cervical cancer, early detection through HPV testing is critical for preventing disease progression. This project capitalizes on the existing infrastructure of HIV clinics for implementation and has evaluated two distinct testing platforms: centralized testing and near point-of-care testing.
By 2021, the initiative had expanded HPV testing across all 10 provinces, with 10 regional central laboratories operational. This expansion aligns with the World Health Organization’s (WHO) global initiative to eliminate cervical cancer, aiming for 90% HPV vaccination coverage, 70% screening coverage, and 90% treatment and care coverage by 2030. Remarkably, over 110,000 HPV tests have been conducted since the program’s inception, with more than 40,000 women screened in 2023 alone.
One success story is that of Kasonde, a retired school teacher from Kabwe, who was diagnosed with early-stage cervical cancer in 2020. Following surgery at the Cancer Diseases Hospital in Lusaka, she made a full recovery. Kasonde’s experience underscores the life-saving potential of early detection and treatment, and she advocates for HPV testing among women, highlighting its benefits over the previously available screening methods.
The scale-up of HPV testing has been supported by the Zambian government and international partners, including the United States President’s Emergency Plan for AIDS Relief and the Global Fund. The program has also introduced self-sampling to enhance accessibility and convenience for women. A noteworthy approach being implemented in 345 facilities is the single-visit screen and treat method, which also offers the self-sampling option.
Despite the progress, the transition to HPV testing has encountered challenges, including the need for developing specific guidelines for HPV testing, improving data management systems, optimizing the supply chain for tests and consumables, reducing result turnaround times, and bolstering counselling services and program retention.
The WHO has provided Zambia with both technical assistance and funding to develop HPV testing and national cervical cancer screening guidelines, and to procure HPV tests and consumables, especially for underserved regions. Efforts to strengthen the program further include training for nurses and laboratory staff, enhancing the supply chain, increasing testing on near-to-point of care test platforms to minimize follow-up losses, and establishing a registry system for follow-up care. Additionally, the use of SMS messaging and phone calls has been implemented to notify clients about their test results.
The ongoing transition to HPV testing has yielded notable achievements, such as an increase in funding partners and the successful integration of HPV testing into the HIV treatment and care program. Looking ahead, a sustainability roadmap is being considered to ensure the program’s longevity, aiming to expand beyond the focus on HIV care and treatment services to include the general population.
Dr. Kennedy Lishimpi, of the Permanent Secretary, Technical Services Department, emphasizes the Zambian government’s dedication to accelerating progress towards the WHO’s 2030 targets. Through the HPV testing initiative, Zambia aspires to significantly reduce the burden of cervical cancer and save the lives of countless women, marking a critical step forward in public health for the nation.