Uganda Tests Strategies for Cervical Cancer

Sunday, April 26, 2009

Ugandan health officials are mulling the results of two pilot projects involving the HPV vaccine that test different ways to reach the nation's girls. One project adds the vaccine to existing public health programs; the other is based in schools.

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School-Based Strategy

In Ibanda, the western district, the government's strategy was school-based.

All girls in "primary 5" or fifth grade were vaccinated. Health workers reported that using the existing school networks made it easier for follow-ups, which are key since the vaccine requires three doses in order to be effective.

The time span to administer the treatment can vary with the drug's brand, but usually the injections must be given over a six-month period. GlaxoSmithKline, a London-based pharmaceutical giant that makes a vaccine for HPV, donated the immunizations for the project.

Parents had numerous concerns about the safety of the vaccine, but Emmanuel Mugisha, the country manager for PATH, said many fears were allayed by an extensive awareness campaign that the Health Ministry conducted in the two districts.

"Before we began vaccinations, we ran programs on television and radio talk shows, handed out education materials, showed films, held community meetings and involved political leaders to talk to the general public," said Mugisha.

Stealthy Disease

In its advanced stages, cervical cancer can cause women to bleed between menstrual periods, emit a foul-smelling discharge and suffer lower abdominal pain. Eventually, the bleeding can become severe and cause death, or the cancer spreads to other parts of the body.

Preventive efforts are hindered by the silent quality of the disease in its early stages. Women can go many years, while the disease is progressing, without any symptoms. This lack of visibility lowers the incentive to travel long distances for screenings, particularly when both time and money are scarce.

So while the vaccination program is considered important here, the push for screenings is also critical.

Many women are still afraid to even enter a gynecologist's office, said Achieng. The idea of undressing for a doctor and having the cervix examined makes many women feel extremely uncomfortable.

Some activists are hoping that a do-it-yourself testing kit will come along soon, based on a simple new test that has been gaining ground with clinicians. The test can be performed with a small mirror, vinegar and a bright light, in the privacy of a woman's own home.

In the United States, about 1-in-4 female teens have received a HPV vaccination, according to federal health officials.

More than a hundred variations of HPV have been discovered, but not all types increase the risk for cervical cancer. The two vaccines administered by a growing number of governments around the world are effective in protecting women from about 70 percent of all HPV types found worldwide, including the ones that can lead to cervical cancer.

PATH is conducting three similar demonstration projects in Peru, India and Vietnam. The demonstration project in Peru was held in 2007, Vietnam's project began in 2008 and is ongoing and the one in India will begin in 2009.

Rebecca Harshbarger is a journalist based in Kampala, Uganda.


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