Cervical cancer can be eliminated through vaccination, screening, and early treatment, yet it is still the most common cause of cancer deaths among women in sub-Saharan Africa. In an effort to combat the devastating effects of this disease, the First Lady of Rwanda, Madam Jeanette Kagame, tasked BVGH and the Rwandan Biomedical Center (RBC) with introducing cervical cancer screening and treatment services in the Bugesera District of Rwanda. Located 25 miles south of the capital city of Kigali, Bugesera District is home to over 50,000 Rwandan women who are at risk of developing cervical cancer.
With the support of experts worldwide, BVGH and RBC led the Cervical Cancer Educate, Screen, and Treat (EST) program to position Bugesera District to achieve the World Health Organization’s (WHO) cervical cancer elimination targets. Since the launch of its human papillomavirus (HPV) vaccination campaign in 2011, Rwanda has successfully surpassed target number one of the WHO’s cervical cancer elimination initiative – i.e., 90% of girls fully vaccinated against HPV by age 15. The EST program would enable Bugesera District to fulfill the two remaining objectives, namely 70% of women screened and 90% of women with cancer/precancerous lesions treated.
Through the EST program, BVGH and RBC placed screening and treatment instruments, equipment, and consumables at the 16 health facilities serving Bugesera’s urban and rural communities. More than 650 healthcare professionals – including nurses, midwives, community health workers, and data managers – were subsequently taught about cervical cancer and the use of the instruments. BVGH, RBC, and EST program partner GardaWorld produced posters, flyers, note cards, and GardaWorld vehicle car wraps to raise awareness of cervical cancer and the screening services to be launched.
Over the four-week launch campaign, more than 6,500 women were screened for cervical cancer. Participants requiring additional screening or diagnostic services, including colposcopy, loop electrosurgical excision procedure, and biopsy at the district hospital or cancer diagnosis and treatment in Kigali, were provided with free transportation by GardaWorld to eliminate the known obstacle to follow-up care. After the launch campaign, RBC and the health facilities took over management of the program. Cervical cancer screening and treatment are now permanent offerings at all of Bugesera District’s health facilities. By building screening into current health services and structures, BVGH and RBC positioned Bugesera District to sustain the momentum generated by the EST program and achieve cervical cancer elimination.
Six months following the launch campaign, BVGH and RBC conducted an in-person refresher training course for the District’s healthcare providers. Over 40 nurses and midwives from Bugesera’s health facilities attended the four-day training, revisiting cervical cancer screening techniques, triage of women with suspected cervical cancer, communication skills, and more. Responding to the healthcare workers’ concerns about the expertise needed to diagnose cervical disease accurately through visual inspection with acetic acid (VIA), BVGH and RBC introduced the Bugesera healthcare providers to Smartphone-Enhanced VIA (SEVIA). Developed by Queens University in Canada and the Tanzanian Ministry of Health (TMOH), SEVIA is a mobile application that improves the quality and accuracy of VIA through the digital review of high-resolution cervical images by local and international experts. BVGH, RBC, Queens University, and TMOH are currently evaluating the use of SEVIA in the Bugesera District. If the results are promising, RBC will consider integrating the technology into Rwanda’s nationwide cervical cancer screening programming.
The EST program was funded by Johnson & Johnson, GardaWorld, and Faber Daeufer & Itrato PC. Administrative support was provided by Nyamata District Hospital.
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