Boosting cervical cancer screening in women living with HIV in Zambia

“I went for HIV services and I was advised by the nurse to get screened for cervical cancer too, as cervical cancer screening has been integrated in HIV services,” says Ruth Zulu, 52, who lives in the Zambian capital Lusaka.

In 2018, Zambia began integrating cervical cancer screening in HIV treatment and care services. Around 235 000 women living with HIV have been screened from November 2020 to October 2021. The country has seen an increase of over 30% in cervical cancer screening rates among women living with HIV over the past year. Zambia continues receiving technical and financial support from WHO towards the cervical cancer elimination initiative.

The initiative to integrate cancer screening in HIV care aims to raise awareness of the disease and increase access to cervical cancer screening which will lead to reduction of new cases and deaths through early detection and treatment, says Dr Abel Kabalo Kabalo, Director of the Department of Health Promotion, Environment and Social Determinants at the Zambian Ministry of Health.

“Women found with early abnormal cells on the cervix (precancerous cells) are treated with thermal ablation right here in the clinic. Those with complex cervical disease are referred to the doctor. Thermal ablation is an outpatient procedure which takes a few minutes, and the patient can go back home after post-treatment counselling,” says Naomi Mushota, a nurse at Kalingalinga Clinic in Lusaka.

Women living with HIV are given information on cervical cancer screening in the HIV clinic. Those eligible for screening are taken through the process by treatment assistants. Once they complete the HIV routine care they proceed to cervical cancer screening within the HIV clinic space or cervical cancer clinic at same facility. The patient is given further information on screening in the cervical cancer clinic and taken through the process. Visual Inspection with Acetic Acid is the method used for screening, but it is enhanced with digital imaging.

Zambia has the third highest number of cervical cancer cases globally, with 65.5 cases per 100 000 women and 43.4 deaths per 100 000 women recorded. Cervical cancer is the most common cancer in Zambia accounting for 23% of all cancer cases. This translates to an estimated 3100 new cases and 1900 deaths annually. Women are the most affected by HIV, with a prevalence rate of 14.2% compared with 7.5% among men.

“I was lucky to be found with early abnormal cells which were treated by the nurse just here at the clinic. My review has shown I no longer have abnormal cells. The cervix is normal. I encourage other women to get screened for cervical cancer,” says Vivian Banda, who was recently screened for cervical cancer.

Dr Kabalo notes that integrating cervical cancer screening within HIV/AIDS programmes should be scaled up to increase access. “Women living with HIV are six times as likely to develop cervical cancer as compared with those who are HIV negative,” he explains.