At the 2016 CCIH Annual Conference, Evan Novalis of IMA World Health discusses the organization's efforts to integrate its HIV/AIDS programs with cervical cancer screening and care.

1. Integration of HIV/AIDS and
Cervical Cancer Programs for
Improved Health Outcomes
in Tanzania
CCIH 30th Annual Conference
June 18, 2016
Evan Novalis
IMA World Health

2. Organizational Overview
• IMA World Health (IMA) is a nonprofit, international
public health organization with faith-based roots
• Mission: Health, Healing and Well-Being for All
• 20 years in Tanzania implementing health projects –
NTDs, HIV/AIDS, MCH, NCDs (Cervical Cancer and
Burkitts Lymphoma) and Nutrition including health
systems strengthening components
• Works in close collaboration with government, faith-
based partners and communities

3. Map of Tanzania and Locations of
Hospitals with Integrated
LEAD/Cervical Cancer Programs

4. Magnitude of Cervical Cancer & HIV
• Cervical cancer is the second most common cancer in women worldwide1;
and ranks #1 of the top 10 cancers affecting women in Tanzania2. It
accounts for 40% of all Cancers at Ocean Road Institute of Cancer (ORCI).3
• HIV prevalence in Tanzania is 5.3% (Prevalence higher among women
6.2%, than among men 3.9%).4
• HIV infected women are 8 times more likely to develop invasive cervical
cancer than women not infected.5
• Some types of human papillomavirus (HPV) substantially increase the risk
of cervical cancer.6
• HIV+/ HPV infected women:
o have an increased risk of developing precancerous lesions, which may
progress rapidly to cervical cancer.7

5. Overview of Cervical Cancer
Prevention and Control Program
(CECAP)
• Spearheaded by the Ministry of Health and Social
Welfare and supported by implementing partners
including the Christian Social Services Commission
(CSSC) and IMA since 2011.
• Funded by CDC Tanzania and private donors.
• Under MOHSW’s Tanzania Service Delivery Guidelines
for Cervical Cancer Prevention and Control.

6. Overview of HIV/AIDS Project
The Local Partners Excel in Comprehensive HIV & AIDS
Service Delivery (LEAD) Project
• Designed to strengthen and scale up quality HIV care and
treatment, TB/HIV and PMTCT services in Tanzania
• Supports MOH in the implementation of the National
HIV/AIDS Strategic Plan
• Funded by PEPFAR, through CDC Tanzania
• Implemented by IMA and other partners on a
consortium led by Catholic Relief Services

7. Implementation of an Integrated
Approach
Phase 1: Assessment
• Assess need and
demand of cervical
cancer services.
• Review of health
facility records.
Phase 2: Site
Readiness
• Advocacy meetings
• Facility assessment
• Procurement
• Training on Visual
Acetic Acid
(VIA)/Cryotherapy
Phase 3: Service
Delivery
• Single Visit
Approach (SVA)
• Care and treatment
at same site
• Integrated daily
screenings
• Community
Mobilization
• Outreach screening
services

8. Implementation
Mwanza
Regional
advocacy
meeting
Facility
assessment at
Magu District
hospital

9. Implementation
Training (lecture and practical) of Health
Care Workers

10. Implementation
Women waiting for
screening services

11. Results: Total Screened by Age Group
1059
5765
7153
6118
3435
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Age <20 Age 20-29 Age 30-39 Age 40-49 Age 50+
Number of Women
Screened
Age Groups of Women Screened for Cervical Cancer
TOTAL SCREENED = 23,530
5%
25%
30%
26%
14%

12. Results: Total VIA+ by Age Group
589
421
322
70
0
100
200
300
400
500
600
700
Age 20-29 Age 30-39 Age 40-49 Age 50+
Number of Women
Screened
Age Groups of Women Screened for Cervical Cancer
TOTAL VIA+ = 1,402
42%
30%
23%
5%

13. Findings
– Utilizing existing resources: Over 100 health care workers (120 nurses, 40 clinicians)
in Mara & Mwanza regions have been trained in the VIA/Cryotherapy procedure.
– Single Visit Approach: 86% of the women screened and with VIA positive results
were treated on the same day and 14% referred for further management.
– Supporting Improved Health Services: Facility renovations conducted at 3 health
facilities such as installing water systems , AC units and cervical cancer screening
rooms.
– Cost-effectiveness: A bottle of Acetic Acid costs 3.5 USD and can run 90 tests.
– Multiple Stakeholder Collaboration: Multi-stakeholder collaboration in planning,
implementation and monitoring is key to the sustainable approach of the programs
at the national, regional and district levels. These stakeholders include:
o National Non-Communicable Disease Department (NCD-MoHSW),
o Reproductive and Child Health Section (RCHS-MoHSW)
o Ocean Road Cancer Institute (ORCI)
o Christian Social Services Commission (CSSC)

14. Testimonials
Some Quotes from women screened
• “The CTC Nurse explained to us about the increased risk of
getting cervical cancer when one is HIV positive. Since then,
we (HIV+ clients) are motivating each us to get screened
annually”
• “I have just been screened for HIV, cervical and breast
cancers. Nurses are friendly, the test is simple and not
painful. I feel very happy and free of these burdens”

15. Recommendations
• Continued integration of cervical cancer interventions
into HIV/AIDS programs for optimization of resource
utilization and improved health outcomes.
• Integration of CECAP into health system components to
enable continuous program strengthening and
sustainability.
• Strengthen referral system for complicated cases through
provision of LEEP and punch machines at all Regional
Hospitals to increase client access to advanced services.
• Continued advocacy to donors on the importance of
integration of Cervical cancer programs into HIV care and
treatment programs.