Abidjan, Côte d’Ivoire – Mariam Cissé could not have expected the shocking news that a precancerous lesion had formed on her cervix when she went for her annual exam at a treatment center that offers outpatient care and counseling in Abidjan. After all, the 41-year-old, HIV-positive mother of three had been screened just a year earlier. To make matters worse, Mariam faced limited treatment options.
Mariam had been screened for precancerous lesions in January 2011 through a technique called visual inspection with acetic acid, or VIA, during which no abnormalities were found. When lesions are found, women can usually receive immediate cryotherapy to treat them. But women who are HIV-positive are at greater risk for more aggressive precancer. And at Mariam’s next annual exam a year later at the same treatment center, a precancerous lesion was found, and she was told it was too large to be treated with cryotherapy.
Upset by the news, Mariam was full of despair until she received a phone call from Midwife Emilienne Nouho at the University Hospital Centre in Treichville. The midwife explained to Mariam that an outpatient treatment for cervical lesions that were too large for cryotherapy, called loop electrical excision procedure, or LEEP, was available and free of charge at the hospital. Midwife Nouho, who has received training in cervical cancer prevention and treatment from Jhpiego, coordinates follow-up care for patients like Mariam.
Thanks to funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Jhpiego has been working with the National HIV/AIDS Care and Treatment Program (PNPEC) to make cervical cancer prevention and treatment with VIA, cryotherapy and LEEP a reality in Côte d’Ivoire.
Since 2009, the number of sites that offer cervical cancer screening and treatment services has grown to 20. Two referral sites provide LEEP. A total of 100 providers and 11 national trainers have been trained in the screen-and-treat approach, and eight providers have been trained in LEEP. To date, 7,343 HIV-positive women have been screened with VIA. Of these women, 365 with small lesions were treated with cryotherapy, while 64 others, including Mariam, received treatment with LEEP.
These are important strides in a country where the cervical cancer screening coverage of women is only 5.8 percent, and where almost 70 percent (1,095) of the 1,600 women who are diagnosed annually with cervical cancer die from the disease, according to the World Health Organization.
The success of the project in Côte d’Ivoire is the result of a close collaboration with the Ministry of Health and PNPEC. Jhpiego has also benefited from the support of other organizations such as the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), the International Center for AIDS Care and Treatment (ICAP), HAI, SEV-CI, ARIEL and ACONDA. These partnerships are vital for continued sustainability and scale-up.
At the encouragement of Midwife Nouho, Mariam attended a counseling session to learn more about her options and, in particular, about LEEP. After attending the session, Mariam decided to undergo the LEEP procedure. She was treated at University Hospital Centre last March by Dr. Annick Ori Zahui, who had been trained by Jhpiego as a LEEP provider.
Mariam remained in contact with Dr. Ori after the procedure was performed and now waits for her one-year follow-up visit to the hospital.
“I am a living testimony to the success of this approach. . .,” Mariam says, the relief visible on her face. “LEEP is a good opportunity for the country. If I was healed, other women could have the same chance.”
To this end, Mariam is working to raise awareness among women’s self-help groups in her neighborhood to encourage them to be tested for cervical cancer. “Relieved,” she says, “I am truly free.”