El Salvador: The Cervical Cancer Prevention Program (CAPE)
Cervical cancer is the third most common cancer among women and the fourth leading cause of cancer-related deaths in women worldwide. Globally, it is estimated that more than 500,000 cases and 250,000 deaths occur annually due to cervical cancer and greater than 85% of these cases occur in developing countries. Cervical cancer is also the leading cause of cancer death amongst women in El Salvador.
In October 2012, BHI received a donation from the pharmaceutical company Qiagen of several thousand low cost HPV DNA tests (careHPV). With this gift, BHI launched a pilot program with the Salvadoran MOH entitled Cervical cAncer Prevention program in El Salvador (CAPE). Each phase of the program turns more control over to the MOH, and it is anticipated that by 2019 the program will be run entirely by the MOH.
Phase 1 of the project, completed in May 2013, resulted in the screening of over 2,000 women who previously had limited access to cervical cancer screening and treatment. The study found that targeted outreach to under-screened women successfully identified women with possibly higher HPV risk and disease burden. Phase 2 of the project was recently completed this past year, enabling 8,035 women, age 30-49, to access cervical cancer screening methods and technology. Again, the results showed that utilization of targeted recruitment methods and outreach, with the help of local Health Promoters, increases the number of women reached. In addition, women referred for colposcopy, as opposed to direct screen and treat methods, were less likely to return for follow up.
Nested within the CAPE study, BHI has also invested time and effort in research that focuses on finding innovative and novel solutions to problems regarding access, acceptance of cervical cancer screening methods, and treatment modalities and technology. In line with its mission to eradicate cervical cancer, BHI has engaged in multiple projects involving self-sampling, addressing the problem of reaching women who are either uncomfortable with provider sampling or unable to travel to a nearby clinic for screening, cryotherapy and the development of innovative, portable, and sustainably affordable modalities of therapy using this technology, as well as cost-effective and program implementation research. BHI is dedicated to its goal of providing women access, not only to cervical cancer screening programs and treatment modalities, but also to the latest in available medical technology and highest standard of available care.
By taking a multi-faceted approach to solving this global issue, BHI wants to create models that can be emulated by other countries and adapted for other low-resource settings. CAPE is now in its third and final phase, and by the end of 2015 a total of 30,000 women will have been screened, providing researchers with the knowledge of the most effective methods of integrating HPV testing into a fully realized national screening program. The CAPE project has set a precedent for combating cervical cancer in resource poor countries with innovative technology. This program will not only establish an infrastructure for a sustained system of cervical cancer prevention in El Salvador; it creates the framework for a viable model of replication in resource-poor countries worldwide. The results of this pilot project will be replicated and packaged to create cervical cancer programs in developing countries worldwide and to strengthen already existing programs in developed nations. Working with the highest level of rigor in the developing world, this prevention model will serve as a sustainable template for countries across the globe, eventually resulting in the complete eradication of cervical cancer on a global scale.