Cervical Cancer is one of the most pressing women’s health issues. It is the 4th most common cancer found in women globally, despite being largely preventable through HPV vaccination, regular screening and the treatment of precancerous lesions. 88% of the related global health burden is borne by Low- and Middle-Income Countries (LMICs). Uganda has one of the highest incidence rates of cervical cancer in the world (56.2 per 100,000), and cervical cancer remains the leading cause of cancer related deaths for women in both Uganda and Tanzania.
Summary
Uganda has had a national roll out of HPV vaccinations for several years, however there is nationally low uptake and coverage. Other problems affecting Uganda’s screening programmes are a lack of trained staff, sociocultural factors (including a lack of public awareness), and lack of quality-assured screening programmes. Most existing screening programmes lack functional referral systems and do not reach target populations. There were previously no cervical screening facilities in Fort Portal, meaning women had to travel over 6 hours to Kampala to access screening. Many women could not afford this journey and were therefore left without access to this vitally important service.
We have begun plans to expand our Cervical Screening Programme to Zanzibar. Please click here if you wish to read more, and would like to support the project by donating!
Activities
The Cervical Screening Project
K4C's Cervical Screening programmes initially started out as The Cervical Screening Project. This activity was initially funded by a £1,500 donation from a group of nursing students from Liverpool John Moore’s University. They had completed their elective placements through K4C and had highlighted the need for the service. Their funding helped K4C to develop its first cervical screening unit at Kagote Health Centre in Fort Portal. This included renovating the unit and purchasing the necessary equipment, including Enhanced Visual Assessment (EVA) and Cold Coagulation devices. Subsequent funding of £50,000 was received from UKAid to upscale and expand the service model from 1 to 3 sites to include Bukuuku Health Centre and Fort Portal Reginal Referral Hospital and provide intensive user training to staff across all 3 sites.
K4C’s professional volunteers have played important roles in providing comprehensive training to local staff. Other activities have included raising awareness through community engagement, social media and radio broadcasts; conducting a community survey and GPS mapping exercise to improve planning of outreach activities; and establishing a telemedicine service to enable local staff to share images of cervixes and receive ongoing diagnostic mentoring from UK based gynaecologists and oncologists. Where treatment is indicated, K4C has procured a washable and rechargeable Cold Coagulation Device which does not require consumables, thus improving sustainability.
Results of Project
Over the course of the project, over 70 staff have been trained in cervical screening and treatment. To date, over 2000 patients have been screened and 60 have received cold coagulation treatment or referral for further management. The majority of these women would not have otherwise been screened and, as a result, may have gone on to later develop cervical cancer.
Transforming from Project to Programme
Although the UKAid funded project ended in April 2020, K4C has continued to support all three screen and treat services that we have set up. Supported by technological innovations, the model has significant potential to increase screening rates and reduce deaths from cervical cancer. Watch the Youtube videos below to see the work carried out by K4C staff on the Cervical Screening programme in Uganda!
Screening Site Updates
Kasangati, Uganda
Cervical screening is ongoing at Kasangati HCIV. K4C midwives screen on Mondays, and Ministry of Health trained local staff perform screening (through Mild Maid, moving to IDI) on Wednesdays and Fridays. K4C screening targets the whole population (women aged 25-50, of all HIV statuses who have a cervix). Midwives screening through Mild Maid primarily target those who are living with HIV as per the Ministry of Health targets in 2024.
K4C midwives now screen in two ways – with HPV testing and VIA (done in conjunction with the EVA device). Mild Maid now mostly only screen with HPV testing. Those who are found to have pre-cancerous lesions under VIA, or who are positive for HPV, are offered thermocoagulation treatment. If noted under VIA, treatment is given immediately, if HPV positive, women are phoned and asked to return for treatment. We will update the spreadsheet to start collecting data about HPV testing from January 2025. We performed 49 HPV screens this year and treated 5 HPV positive women with thermocoagulation.
When women need treatment, K4C midwives and local midwives will often treat together for mutual support and learning opportunity.
Those who need biopsy are referred to Kawempe National Referral Hospital.
Highlights
- 112 women were screened at Kasangati HC4 by K4C midwives in 2024.
- The average age of clients screened was 32.9 years old
- 68.75% of women screened by K4C midwives are HIV negative.
- Most women are referred from ART clinic and OPD, with a few from Postnatal or Family Planning.
- 3 Women (2.7%) of women screened were found to be VIA positive. Of these, 2 were treated at Kasangati, and one was referred to Kawempe for biopsy.
Fundraiser
As mentioned above, K4C is expanding its Cervical Screening programme to Zanzibar, where there currently exists no public service for screening. Please take a moment to read the KindLink fundraiser and proposal we have set up to support the project. Alternatively, if you wish to donate directly, please click here. Any support you can offer is greatly appreciated.
Research
The UK and Uganda team jointly published a paper in 2023 discussing the results and impact of the cervical screening service. The paper highlights, in detail, the evolution of the see-and-treat center for excellence. This included engaging with the local community to accurately assess where they received their health education, utilising geographic information systems (GIS) to map data and the successful task-shifting of staff employed at Kagote and other health centers: