For more than a decade, Jhpiego has been committed to building local capacity in low-resource settings for the implementation of a “Single Visit Approach” to cervical cancer screening and treatment. The Single Visit Approach involves visual inspection of the cervix after application of acetic acid (VIA), followed by immediate treatment with cryotherapy for eligible lesions, during the same visit. Women in low-resource settings face a number of barriers to accessing care, including lack of funds to pay for transportation and lack of access to health screenings that provide test results and immediate treatment. Combining screening and treatment in a Single Visit Approach greatly reduces the burden on these women.
In addition to this innovative approach to screening and treatment, there is now a vaccine available to protect women against the human papillomavirus (HPV), which has been shown to cause cervical cancer. As the HPV vaccine becomes more affordable and available to governments and stakeholders in low-resource settings, there is an opportunity to explore approaches that will ensure that it reaches all eligible girls. Pilot projects that use a school-based approach to introduce the vaccine have been successfully implemented in various countries.
Recognizing the benefits of ensuring optimal coverage of the vaccine and reaching a greater number of girls, including those who may not have access to schools, Jhpiego initiated a study that integrated provision of the vaccine within existing cervical cancer screening services at health facilities in a “no missed opportunities” approach. The study, called the Mother-Daughter Initiative (MDI), was implemented from February 2011 to July 2012 in Thailand and the Philippines. Its premise was that mothers (or women) who visit clinics and opt to receive cervical cancer screening will be more likely to bring their daughters (or other female relatives) to the clinic for vaccination later. In partnership with Chulalongkorn University in Thailand and the Cancer Institute Foundation in the Philippines, the MDI project recruited 8,005 adolescent girls for the study through the clinics where their mothers received screening. More than 88.1% (Philippines) and 99.8% (Thailand) of the girls received all three doses of the vaccine. The study also included interviews with parents and guardians to assess their knowledge, attitudes and beliefs about cervical cancer, HPV and the HPV vaccine.
The preliminary findings of the study suggest that an integrated approach to introducing the vaccine is feasible and could complement a school-based approach, resulting in a generation of girls who will be protected from cervical cancer.