Simon Manga

Achieving high uptake of human papillomavirus vaccine in Cameroon: Lessons learned in overcoming challenges

BACKGROUND Cameroon has the highest age-standardized incidence rate of cervical cancer (30/100,000 women) in Central Africa. In 2010-2011, the Cameroon Baptist Convention Health Services (CBCHS) received donated human papillomavirus (HPV) vaccine, Gardasil, from Merck & Co. Inc. through Axios Healthcare Development to immunize 6400 girls aged 9-13 years. The aim was to inform the Cameroon Ministry of Health (MOH) of the acceptability, feasibility, and optimal delivery strategies for HPV vaccine. METHODS AND FINDINGS Following approval by the MOH, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage, brochures, posters, and presentations. Because educators were initially reluctant to allow immunization in schools, due to fear of adverse events, the nurses performed 40.7% of vaccinations in the clinics, 34.5% in community venues, and only 24.7% in schools. When no adverse events were reported, more schools and communities permitted HPV vaccine immunization on their premises. To recover administrative costs, CBCHS charged a fee of US

Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon.

8 per 3-dose series only to those who were able to pay. Despite the fee, 84.6% of the 6,851 girls who received the first dose received all three doses. CONCLUSIONS AND LESSONS LEARNED With adequate education of all stakeholders, HPV vaccination is acceptable and feasible in Cameroon. Following this demonstration project, in 2014 the Global Access to Vaccines and Immunization (GAVI) Alliance awarded the Cameroon MOH HPV vaccine at a price of US

Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results.

4.50 per dose to immunize sixth grade girls and girls aged 10 years who are not in school in two districts of Cameroon.

Evaluation of See-and-Treat Cervical Cancer Screening in Human Immunodeficiency Virus–Positive and Human Immunodeficiency Virus–Negative Women in Cameroon [332]

Background In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). Methods We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). Results Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. Conclusions High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.

Challenges with Cervical Cancer Treatment in Cameroon

Objective The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods. Method Three observers, blinded to each others interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas. Results For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47–0.61], A/C, fair (K, 0.37; 95% CI, 0.29–0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37–0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28–0.56); A/C, fair (K, 0.33; 95% CI, 0.20–0.46); B/C, fair (K, 0.54; 95% CI, 0.40–0.67); A/D, moderate (K, 0.59; 95% CI, 0.45–0.74); B/D, moderate (K, 0.58; 95% CI, 0.46–0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63). Conclusions Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.

Assessing the Effectiveness of a Community-Based Sensitization Strategy in Creating Awareness About HPV, Cervical Cancer and HPV Vaccine Among Parents in North West Cameroon

BACKGROUND: Invasive cervical cancer is the second leading cause of cancer mortality among women in Cameroon. To decrease the burden of invasive cervical cancer, the Cameroon Baptist Convention Health Services implemented the World Health Organization-endorsed “see-and-treat” cervical cancer screening program using visual inspection with acetic acid enhanced by digital cervicography. Our aim was determine the prevalence and predictors of a positive screen, rates of same-day treatment, and prevalence of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. METHODS: We completed a retrospective analysis of 33,730 Cameroon Baptist Convention Health Services patients screened between 2007 and 2013. RESULTS: Of the 33,660 cases with valid visual inspection with acetic acid data, 9.5% of women screened visual inspection with acetic acid-positive, 62.7% were visual inspection with acetic acid-negative, and 27.8% were considered “uncertain” as a result of poor visualization of the cervix or concurrent cervicitis. After covariate adjustment in a multivariable logistic regression model, human immunodeficiency virus (HIV)–positive women were 1.33 times more likely to screen visual inspection with acetic acid-positive than HIV-negative women (95% confidence interval 1.16–1.54, P<.001). Other factors associated with visual inspection with acetic acid-positive screens were rural screening location, gravidity, age at sexual debut, and number of lifetime sexual partners. Among women eligible for same-day cryotherapy, only 43% accepted the treatment. Pathology specimens (n=750) collected from women with visual inspection with acetic acid-positive lesions ineligible for cryotherapy identified 30% of cases as invasive cervical cancer and 70% as CIN. CONCLUSION: Risk factors for a positive screen included HIV positivity, rural location, and sexual behavior. Less than half of eligible patients opted for same-day treatment. Further studies are required to better identify barriers to implementing same-day treatment protocols.

Awareness, knowledge and beliefs about HPV, cervical cancer and HPV vaccines among nurses in Cameroon: An exploratory study

This is a case study of women with Invasive Cervical Cancer (ICC) and her course of treatment, showing the critical need for prevention through aggressive screening and vaccination programs. Even though cost of treatment was a barrier, she completed her radiation therapy and felt better. Then she experienced an aggressive recurrence associated with bilateral lungs metastasis thereafter and the only option was to refer her for palliative chemotherapy. This report highlights the difficulty faced by patients in getting radiation treatment in Low and Middle-Income Countries (LMIC) like Cameroon. It also supports the view that cervical cancer prevention via vaccination and with routine screening is crucial in addressing the growing burden of cervical cancer in LMICs especially given the cost of access to treatment and dearth of radiation treatment infrastructure.