Report on Cervical Cancer Activity in Kenyarho.org/files/ACS_Kenya_report_2015.pdfREPORT ON CERVICAL CANCER ACTIVITY IN KENYA | 3 Introduction This document was prepared for the American

REPORT ON Cervical Cancer Activity in Kenya

American Cancer SocietyGlobal Health Department

,

REPORT ON CERVICAL CANCER ACTIVITY IN KENYA | 2 REPORT ON CERVICAL CANCER ACTIVITY IN KENYA | 3

Table of ContentsIntroduction ................................................................................................................................................. 3

I. Listing by Activity ...................................................................................................................................... 4

II. Listing by Location .................................................................................................................................... 5

III. Listing by Program ................................................................................................................................... 12

Appendix I: References ................................................................................................................................. 38

January 2015 | Prepared by: Mishka Kohli Cira, Consultant, [email protected]

REPORT ON Cervical Cancer Activity in Kenya

AbbreviationsAPHIA: AIDS, Population, and Health Integrated Assistance

CECAP: Cervical Cancer Program

D/H: District Hospital

DRH: Division of Reproductive Health

FBO: Faith-based Organization

GoK: Government of Kenya

H/C: Health Center

HIV: Human Immunodeficiency Syndrome

HPV: Human Papillomavirus

IEC: Information, Education, and Communication

KEMSA: Kenya Medical Services Association

KENCO: Kenya Network of Cancer Organizations

L5: Level 5 Hospital

LEEP: Loop Electrosurgical Excision Procedure

MOH: Ministry of Health

PGH: Provincial General Hospital

VIA: Visual Inspection with Acetic Acid

REPORT ON CERVICAL CANCER ACTIVITY IN KENYA | 3

Introduction

This document was prepared for the American

Cancer Society’s Global Cancer Prevention Unit

through literature review, interviews (phone and

face-to-face) and via email with governmental and

nongovernmental organizations active in cervical

cancer activity in Kenya. The purpose of the scoping

assignment was to inform internal strategic planning.

It may not include all implementing partners in

Kenya, and it is not intended as a final report on

all cervical cancer activity. The Society consultant

used various methods to learn about cervical cancer

activity in Kenya, including asking for referrals from

known programs and researchers, online searches for

programs, and through cancer control contacts. The

programs in this listing vary in a number of ways, such

as the way they are structured, the focus (e.g. program

vs. training), the funding sources (some are tied to

HIV funding, others are independent), and length of

duration (long-term vs. short-term). We hope this will

be a good starting resource for the Kenyan Cancer

Community to build on and update.

Common challengesWhile each program has unique issues, several programs share similar challenges:

• Lack of support (system, logistic, financial) for patients who need to be referred for advanced treatment

• Inaccessible referral system for patients due to cost, time, stigma, and other issues

• Lack of understanding – and stigma-related misconceptions – about cervical cancer screening purpose, process, and outcomes

• Staffing turnover at public facilities, leading to need to train new providers

• Equipment availability/maintenance/sustainability

• Donor reliance – need for sustainable funding solutions

• Lack of trained providers for screening and treatment

• Lack of provider confidence/capability in treatment skills

• Shifting funding priorities for programs reliant on HIV funds

• Need for better data collection, especially in public facilities


• Challenges with quality assurance

I. Listing by Activity

PROGRAM ACTIVITY EQUIPMENT/MATERIALS

Screening HPV testing

Treatment Training Outreach Research Screening equipment

Treatment equipment

IEC material development

Africa Cancer Foundation

AMPATH-Oncology

AMREF

APHIA Plus Kamili - JHPIEGO

APHIA Plus Western – PATH

Brown University

Cancer Awareness Center Kenya

Centers for Disease Control and Prevention

Early Cancer Care and Detection Center

FACES: Family AIDS Care and Education Services

FHOK: Family Health Options Kenya

Faraja Cancer Support Trust

Hope Beyond Cancer Trust

ICAP: Columbia University

JHPIEGO: Tupange Project

Kenya Cancer Association

Marie Stopes Kenya

Ministry of Health: Division of Reproductive Health

PS KENYA (PSI)

Treatment, Research and Expert Education (TREE)

University of California, San Francisco

University of Manchester; Cancer Research Trust-Kenya

University of North Carolina/KEMRI-Nairobi

U of North Carolina/U of Washington

Women for Cancer Early Detection and Treatment


II. Listing by Location

REGION COUNTY PROGRAM ACTIVITY1 MOH/APHIA CRYOTHERAPY SITES2

NON-GOK LEEP & CRYOTHERAPY SITES3

WESTERN Bungoma AMPATH

APHIA Plus

Western PS Kenya

Bungoma D/H

Webuye D/H

Siboti

Nalondo

Tongaren

Mechimeru

Kopsiro

Webuye D/H (AMPATH)

PS Kenya Clinic

MSK Bungoma Clinic

Busia APHIA Plus Western

PS Kenya

Busia D/H

Port Victoria D/H

Rukala

Madende

Nambuku

Ikonzo

Lukolis

PS Kenya Clinic

Kakamega Africa Cancer Foundation

APHIA Plus Western

FHOK


JHPIEGO

PS Kenya

Kakamega PGH

St. Mary’s Hospital (Mumias)

Mumias MHC

Lugari D/H

Shikunga

Elwesero

Shinyalu

Chombeli

Shiseso

Eshinutsa

Chekalini

Lung’anyiro

PS Kenya Clinic

Vihiga APHIA Plus Western

PS Kenya

Vihiga D/H

Emusire

Banja

Bugina

Lyanaginga

PS Kenya Clinic

NYANZA Homa Bay CDC Kenya

FACES

APHiA Plus Western


Homa Bay D/H

Mbita D/H (FACES)

Sindo D/H (FACES)

Marindi

Wagwe

Ober H/C

Kisii CDC Kenya

Marie Stopes

Gucha West D/H

Luanda H/C

Iranda H/C

Kiogoro H/C

Nyamasibi H/C

Nyamagundo

Kenyerere

Misesi

Moticho

Marie Stopes Clinic

1. Program specifics as presented in Table 1 may vary from location to location.2. MOH/APHIA Cryotherapy Sites refer to government facilities that have received cryotherapy equipment through the Government of Kenya.3. Non-GOK LEEP & Cryotherapy Sites refer to government or nongovernmental facilities that have received LEEP and cryotherapy equipment from non-governmental sources.




NYANZA Kisumu Africa Cancer Foundation

AMPATH

APHIA Plus Western

CDC Kenya

FACES

FHOK

ICAP

JHPIEGO

Marie Stopes

TREE

Nyanza PGH

JOOTRH

Kombewa D/H

Miranga SDH

Manyuanda SDH

Bodi H/C

Gita

Nyamarimba

Chuliambo SDH (AMPATH)

Lumumba H/C (FACES)

Kisumu (FACES)

FHOK Clinic

Ahero (ICAP)

Nyakach (ICAP)

Marie Stopes Clinic

Migori CDC Kenya

FACES

APHIA Plus Western

Migori D/H (FACES)

Kuria D/H

Oyani H/C

God Kwer H/C

Rongo D/H (FACES)

Nyamira APHIA Plus Western

CDC Kenya

Early Cancer Detection & Care Centre

Nyamira D/H

Gesima

Bosiango

Siaya APHIA Plus Western

CDC Kenya

Early Cancer Detection & Care Centre

FHOK

ICAP

Siaya D/H

Bondo D/H

Nyangoma

Usigu

On’gielo

Yala (ICAP)

Bondo (ICAP)

Siaya (FHOK & ICAP)

RIFT VALLEY Baringo Baringo D/H

Mochongoi H/C

Bartabwa

Koloa

Olkokwe

Equator

Bomet Longisa D/H

Siomo

Irwaga

Kiricha

Sirongiroi

Elgeyo-Marakwet AMPATH Kapyego

Cheptongei H/C

Biretwo H/C

Kibendo H/C

Iten DH (AMPATH)

Kajiado FHOK


PS Kenya

Loitoktok D/H

Kajiado D/H

Mile 46 H/C

Entasopia H/C

Immurtot

PS Kenya Clinic

FHOK Clinic




RIFT VALLEY Kericho Kericho D/H

Kapkatet D/H

Londiani D/H

Mtaragon

Manyoror

Kabianga

Kenene

MSK Kericho Clinic

Laikipia PS Kenya Nanyuki D/H

Lamuria

Ndindika

PS Kenya Clinic

MSK Nanyuki Clinic

Nakuru Africa Cancer Foundation

FHOK


Marie Stopes

PS Kenya

Nakuru PGH

Molo D/H

Miruki Kariuki

Kabazi

Rare H/C

Maiela H/C

Nyamamithi H/C

Kiptagich

FHOK Clinic

MSK Nakuru Clinic

PS Kenya Clinic

Nandi AMPATH

PS Kenya

Kapsabet D/H

Serem

Kabiemit

Ollessos

Mosoriot H/C (AMPATH)

PS Kenya Clinic

Narok Marie Stopes Narok D/H

Oldanyati

Olchoro H/C

Morijo Loita

Marie Stopes Clinic

Samburu Maralal D/H

Kisima H/C

Swsari H/C

Trans Nzoia Kitale D/H

Chepchoina

Matunda

Cherangani

MSK Kitale Clinic

Turkana EGPAF Lodwar D/H

Kerio

Elelea

Makutano

Turkana D/H (EGPAF)

SOS Clinic (EGPAF)

Uasin Gishu Africa Cancer Foundation

AMPATH

Brown University

FHOK

Eldoret MTRH

Chepkigen

Moiben

Kiplombe

Kapsisiywa

AMPATH/MTRH (AMPATH)

Turbo H/C (AMPATH)

AMPATH/MTRH Colposcopy (Brown U)

FHOK Clinic

MSK Eldoret Clinic

West Pokot Kapenguria D/H

Lomut

Alale

Ptoyo




CENTRAL Kiambu APHIA Plus Kamili

FHOK



PS Kenya

Women4Cancer

Wangige H/C

Tigoni

Gachororo

Kigoro

Gathanga

Gitiha

Gakoe H/C

Kiganio

Thika Level 5 Hosp

Ngecha

PS Kenya Clinic

FHOK Clinic

MSK Thika Clinic

Kirinyaga APHIA Plus Kamili

PS Kenya

Kerugoya D/H

Sagana H/C

Kimbimbi SDH

Jegas

Mutithi

Kabare

Kangaita

PS Kenya Clinic

Murang’a APHIA Plus Kamili


Marie Stopes

Kangema SDH

Maragua D/H

Kandara

Kaharo

Kambirwa

Gikui

Nyangiti

Nyandarua APHIA Plus Kamili

PS Kenya

North Kinangop Mission Hosp

Ndaragwa H/C

Olkalou D/H

Subuku

Gatimu

Kigumo

PS Kenya Clinic

Nyeri Africa Cancer Foundation

APHIA Plus Kamili

FHOK


Karatina D/H

Mweiga H/C

Nyeri PGH

Ihururu H/C

Karia H/C

Thangathi H/C

Kamoko

Kiamabara

Karatina

FHOK Clinic

MSK Nyeri Clinic




NAIROBI Nairobi Africa Cancer Foundation

AMREF

Cancer Awareness Centre Kenya

CDC Kenya

FACES

FHOK

Faraja Cancer Support Trust


JHPIEGO


Marie Stopes

PS Kenya

TREE

U of Manchester

Women4Cancer

Mbagathi D/H

Makadara H/C

Ngaira H/C

Bahati H/C

FHOK

Westlands H/C

Kahawa West H/C

Lungalunga H/C

Mukuru Reuben H/C

Ngong Rd H/C

Kayole II SDH

St. Mary’s Hosp

Dandora II H/C

St. Francis Hosp

KNH

Mama Lucy Kibaki Hosp

Mathare North H/C

Loco H/C

Langata H/C

Kasino

Kariokor

MSK Kibera Clinic

PS Kenya Clinic

Coptic Hope Center Cryo & LEEP

FHOK Clinic (Cryotherapy)

MSK Eastlegh Nursing Home

MSK Kencom Clinic

MSK Kangemi Clinic

MSK Pangani Clinic

MSK Kenyatta Market Clinic

EASTERN Embu APHIA Plus Kamili

PS Kenya

Embu PGH

Kathanje MHC

Kithimu

Kigumo

Kiritiri

Embu L5 LEEP (APHIA Plus Kamili)

PS Kenya Clinic

Isiolo Isiolo D/H

Kipsing H/C

Gafarsa H/C

Kitui APHIA Plus Kamili


ICAP

Women4Cancer

Kitui D/H

Mwingi D/H

Inyuu

Kisasi

Mutha

Ngomeni

Nthongoni

Ukasi

ICAP

Machakos APHIA Plus Kamili

EGPAF


ICAP

JHPIEGO


Women4Cancer

Machakos D/H

Kangundo D/H

Kimiti

Kinanie

Katangi

Masinga H/C

Mbiumi

Mutituni

Machakos L5 LEEP (APHIA Plus Kamili)

ICAP




EASTERN Makueni APHIA Plus Kamili

ICAP

PS Kenya

Makueni D/H

Makindu D/H

Emali Town

Kalawa

Kambu

Kilala

Mavivye

ICAP

PS Kenya Clinic

Marsabit Moyale D/H

Boru Hare

Kalacha

Logologo

Godoma

Meru APHIA Plus Kamili

FHOK

Marie Stopes

PS Kenya

Meru D/H

Nyambene D/H

Karama

Kiburine

Kionyo

Laare

Mboroga

Mweronkanga

Nthambiro

Meru L5 LEEP (APHIA Plus Kamili)

MSK Meru Clinic

PS Kenya Clinic

FHOK Clinic

Tharaka-Nithi APHIA Plus Kamili Chuka D/H

Tharaka D/H

Gatunga H/C

Kieni

NORTH EASTERN Garissa Ijara D/H

Garissa PGH

Sankuri

Sangailu

Galmagala

Kulan

Mandera Mandera D/H

Banissa

Kotulo Mandera

Fino

Wajir Wajir D/H

Sabuli

Eldas

Mansa

Korndille

COAST Kilifi FHOK

Marie Stopes

PS Kenya

Mariakani D/H

Malindi D/H

Baolala

Gongoni

Jila

Matsangoni

Gotani

MSK Malindi Clinic

PS Kenya Clinic

FHOK Clinic




COAST Kwale PS Kenya Mnyenzeni

Mkongani

Lungalunga

PS Kenya Clinic

Lamu Mpeketoni D/H

Witu

Kizingitini

Mombasa Africa Cancer Foundation

FHOK

JHPIEGO

Marie Stopes

PS Kenya

Port Reitz D/H

Mbuta

Jomvu

Mvita

MSK Mombasa Clinic

PS Kenya Clinic

FHOK Clinic

Taita-Taveta Taveta D/H

Moi Voi D/H

Mgange Dawida

Bura

Maungu

Rekeke

Tana River PS Kenya Ngao D/H

Semikaro

Waldena

Madogo

PS Kenya Clinic


III. Listing by Program

AFRICA CANCER FOUNDATION

Program Type Local NGO

Contacts Dorothy Nyong’o

[email protected]

Duration Started 2011

Activity Screening 10,286 [2012-2014]

Treatment -

Training Volunteers and high school cervical cancer clubs: Mary Leakey Girls’ and State House Girls’ Schools (50 members each)

Outreach Community awareness talks

Other -

Equipment Screening equipment Purchased on needs basis for medical camps

Treatment equipment -

IEC materials ACF-printed IEC materials and materials from other hospitals and organizations

Other

Location(s) Clinic, Municipality, County Nyeri County; Kisumu County; Nakuru County; Mombasa County; Kakamega County; Eldoret, Uasin Gichu County; Nairobi City County

Partners Funding partners Philips East Africa, Pan Africa Life Assurance Ltd, Sanlam, AstraZeneca, Brainwave Communications Ltd, Eagle Africa Ltd, AON Kenya Insurance Brokers Ltd, MTN Insurance Agencies, Chase Bank, Next Technologies, Family Bank, Newline Ltd, Compulynx Ltd, Simba Colt, Coca Cola, Wanderjoy Party World, Laikipia University

Collaborating partners Medical Society for Action

Hospitals Public & private hosipitals

Universities Laikipia University, Masinde Muliro University of Science and Technology

Research Topic Prevalence/types of cancer in Kenya; diagnostic and treatment capacity of health centres

Location Uasin Gichu County, Nairobi City County, Mombasa County, Machakos County, Nakuru County, Nyeri County, Isiolo County, Kisumu County, Kakamega County, Baringo County

# of participants 1,000 patient records, 10 facilities

Status On-going

Partners The Rockefeller Foundation

Challenges Financial • Funding to hold free public screening

Non-financial • Providing post screening solutions such as supporting patients through treatment

• Misconceptions on cancer screening, e.g., that the procedure involves scrapping off cell tissue in the cervix hence very painful

Data Source Name Margaret Muthura

Date 24 September 2014

Mode Via email


AMPATH-ONCOLOGY

Program Type International collaboration

Contacts Patrick J. Loehrer, MD, Indiana University School of Medicine

[email protected]; Frederick (Chite) Asirwa, MD, [email protected]; Elkanah Omenge Orango, MD; John Oguda, MD, Associate Program Manager,

AMPATH-Gyn-Oncology/Cervical Cancer Program

[email protected], tel: 0721 821 530

Duration Started 2009 as research study; 2010 became part of AMPATH, 2011-12 expanded to 6 additional clinics

Activity Screening 550/month, 27,804 total [as of 31 Aug 2014]

Treatment 15% of those screened [cryotherapy 1059, LEEP 485, +radical hysterectomy]

Training 23 nurses [screening and treatment]; Gyn-oncology fellowship[2 completed, 3 current]

Outreach -

Other Registry, Pharmacy, M&E

Equipment Screening equipment VIA

Treatment equipment Cryotherapy [6 machines], Colposcopy [4], LEEP [4], Chemotherapy

IEC materials Program-specific IEC materials developed (posters & postcards)

Other Care protocols [diagnostic, chemotherapy]

Location(s) Clinic, Municipality, County AMPATH Center, Eldoret, Moi Teaching and Referral Hospital MCH Clinic, Eldoret, Turbo H/C, Uasin Gichu County; Webuye DH, Bungoma County; Mosoriot H/C, Nandi County; Iten DH, Elgeyo/Marakwet County; Chuliambo sub-DH (119km), Kisumu, Kisumu County

Partners Funding partners US AID/AMPATH, Pfizer

Collaborating partners Indiana University, Brown University, U of Toronto, existing HIV infrastructure

Hospitals Moi School of Medicine

Universities See Collaborating partners

Research Topic(s) Cryotherapy follow-up study (completed); Comparison of cervical treatment outcomes in HIV-positive vs. HIV-negative women; Comparison of LEEP and cryotherapy; Use of referrals by community health volunteers (through existing HIV structures); Post-cryotherapy follow up/treatment (proposed)

Location(s) AMPATH Center, Webuye Clinic, Chulaimbo Clinic

# of participants N/A

Status On-going, except where noted

Partners Indiana University, Brown University, U of Toronto, Ministry of Health, Moi University, Moi Teaching and Referral Hospital

Challenges Financial • Funding sustainability

• Staffing (need to rely on MOH staff, who are needed in other depts.)

• Study-specific staff can’t continue past contract despite work load

Non-financial Program

• Equipment: donated, has no maintenance contract, difficult to maintain, use some as mobile equipment to make up for broken ones

• Lack of IEC materials

• Supplies – hard to source locally/expensive, rely on donors

• Expansion: increased demand but lacking supplies, staff, funding

Research

• Subject retention

• Staffing

• Specimen/sample turn around time

Data Source Name Strother et al. 2013, Dr. Oguda


Mode Via phone


AMREF: AFRICA MEDICAL RESEARCH FOUNDATION

Program Type International NGO

Contacts Lilian Mbau, MD, [email protected]

Duration Started 2011 (one clinic, since expanded to total of 5)

Activity Screening +3,000 women using VIA/VILI

Treatment Referrals: Initially only 50% successful referral rate to Mbagathi and KNH. Now partnered with FHOK with notable improvement.

Training Healthcare worker training (3 trainings/30pax per training)

Outreach Clinic outreach programs and community mobilization

Other Training and awareness through AMREF Maternal & Child Health programs country-wide

Equipment Screening equipment Screening equipment (VIA/VILI)


IEC materials In-house IEC materials

Other -

Location(s) Clinic, Municipality, County Kibera Community Health Centre (AMREF/MOH), Kibera, Ushirika Medical Clinic (NGO), Kibera, Langata health centre (MOH), Nairobi, Uhuru A.P. Camp Dispensary, Nairobi, Nairobi City County

Partners Funding partners CDC, MOH

Collaborating partners MOH, FHOK, Tupange/JHPIEGO, Hope Beyond Cancer Trust, African Cancer Foundation

Hospitals See Clinics

Universities -

Research Topic Introducing Cervical Cancer Screening in an Urban Informal Settlement

Location Kibera Community Health Centre

# of participants 186

Status Abstract presented in international conference

Partners MOH, CDC

Challenges Financial CDC funding no longer available to support screening activities

Non-financial • Referral issues

• Cryotherapy training (Langata HC has cryo from APHIA Plus, but no trained staff)

• Lack of treatment equipment (Cryotherapy) despite high screening volumes, maintenance & training

• Medical supplies (CDC funding no longer available), Quality assurance and supervision of clinicians

Data Source Name Lilian Mbau, MD


Mode Meeting at AMREF


APHIA PLUS KAMILI/JHPIEGO

Program Type International/Local Collaboration

Contacts Mildred Mudany, MD (Jhpiego), APHIA Plus Chief of Party, [email protected]

(254) 733 440 512

Dr. Ruth Johonga (Machakos) 0722 639 705, [email protected]

Dr. Regina Mbayaki (Machokos) [email protected]

Duration Started 2010 (now in 4th of 5 year USAID program)

Activity Screening Screening activities (VIA/VILI) integrated with key dates/on request (40,000+ screened – 5% positivity rate)

Treatment Single-visit approach & referral

Training Clinical training VIA/VILI, Cryotherapy (8 gynecologists, 24 nurses); Disseminated M&E tools & national guidelines

Outreach Community mobilization

Other Mentorship (200 clinicians); Data collection tool distribution/mentorship; Supported DRH in vaccination pilot establishment through school health program (Kitui County); Participated in development of M&E tools

Equipment Screening equipment Speculums, reagents, etc for VIA/VILII

Treatment equipment Cryotherapy (24 machines); LEEP (3) – Meru L5, Embu L5, Machakos L5

IEC materials -

Other CECAP data collection tools (Jhpiego worked with DRH to develop)

Location(s) Clinic, Municipality, County County list (11): Makueni; Machakos; Kitui; Embu; Tharaka Nithi; Meru; Nyeri; Muranga; Kirinyaga; Kiambu; Nyandarua

Note: Meru L5 is an excellent model – funds supplies through fee-for-service outreach; county nurse is cryo champion-includes training as minimum standard of care for all staff (including rotational staff)-objective to have 80% staff trained

Partners Funding partners USAID

Collaborating partners MCHIP, Community partners (demand creation)

Hospitals Local clinics/facilities

Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • USAID changing funding priorities – no longer able to do outreach to non-HIV population

Non-financial • Despite single visit approach, only 43% of patients stay for treatment

• Despite distribution of CECAP tools, low usage and return of data – supposed to be uploaded to DHIS, but only get data if Jhpiego reaches out to facilities

• DRH approach to distribution machines – done without training so staff do not use

• High staff turnover

• Need DRH/GoK/Counties to recognize this as a need

• Devolution issues – need to engage each county

• Challenge to create demand if services do not exist

• Need better data collection/analysis methods

• Facilities run out of supplies, lack space for machines

• Need to strengthen advocacy at national level to remove reliance on donors and give voice at county level

Data Source Name Dr. Mudany, Dr. Johonga, Dr. Mbayaki


Mode Meeting at JHPIEGO


APHIA PLUS WESTERN/PATH

Program Type International/Local Collaboration

Contacts James Mukabi, MD, (APHIA Plus Western Kenya), [email protected], 0722-565-432; Cornelius Kondo, [email protected]; Jose Jeronimo, PATH-Seattle Researcher (can get contact from Elisabeth Vodicka); Robyn Wilmouth, MScEng, Special Initiatives Manager, PATH Kenya Country Program, Technology Solutions Global Program, [email protected], +254 (0)708 285 476; Allison Bingham – PATH-Seattle ([email protected])

Duration 2011-2013 [intended to end 2015, but change of priorities]

Activity Screening Integration of cervical cancer screening into health services (single visit approach) (48,196/2013 757 sites, static & outreach)

Treatment See Screening

Training Capacity building in screening and use of cryotherapy (351), Supervision

Outreach CHW capacity building in health education and mobilization

Other Dissemination of policies and guidelines; Distribution of CECAP tools

Equipment Screening equipment N/A

Treatment equipment Cryotherapy machines (13)

IEC materials IEC Materials from MOH and other partners

Other -

Location(s) Clinic, Municipality, County 757 static and outreach sites in Nyanza and Western;

Clinic support: Kakamega, Kisumu, Nyamira South, Siaya, Vihiga, Bungoma South, Busia, Mumias, Emuhaya, Lugari

Partners Funding partners CDC, USAID

Collaborating partners MOH

Hospitals See clinic list

Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Inadequate Supplies / Commodities/ Consumables

• Infrastructure constraints (space/equipment): Patient examination couches/ lighting systems/ speculums/ sterilizers etc.

Non-financial • Coverage: The proportion of HFs offering the service is limited, about 35% in Nyanza and 40% in Western.

• Inadequate number of HCWs trained to proficiency to offer screening/ Cryotherapy services.

• Frequent breakdown of Cryotherapy machines affecting the single visit approach to CECAP service provision.

Data Source Name Dr. Mukabi

Date 6 October 2013

Mode Via email


BROWN UNIVERSITY

Program Type International Collaboration

Contacts Susan Cu-Uvin [contact from Jennifer Smith]

Duration N/A

Activity Screening Approx. 17,000 women, in connection with study, including HPV testing

Treatment Colposcopy

Training N/A

Outreach N/A

Other -


Treatment equipment Colposcopy

IEC materials N/A

Other -

Location(s) Clinic, Municipality, County MTRH/AMPATH, Eldoret, Uasin Gichu County

Partners Funding partners AMPATH

Collaborating partners N/A

Hospitals MTRH

Universities N/A

Research Topic N/A

Location N/A

# of participants N/A

Status N/A

Partners N/A

Challenges Financial N/A

Non-financial N/A

Data Source Name Jennifer Smith


Mode Kenya HPVTesting document 18 November 2013


CANCER AWARENESS CENTRE KENYA

Program Type Community Based Organization (CBO)

Contacts Boniface Mbiuki, [email protected]

Margaret Keige, [email protected]

Office: [email protected]

Duration Started 2011

Activity Screening Medical camps 2011-2014, 6,000 women (cervical & additional cancers)

Treatment Referral to private/public hospitals

Training Nurse training planned for 2015

Outreach Corporate cancer screening, social media, blog, awareness talks

Other Patient support program with partner hospital (support group and financial support) – planned for 2015

Equipment Screening equipment Pap kits, VIA/VIli supplies, speculums


IEC materials IEC materials from KENCO partners and MOH; plan for future development of IEC materials in-house

Other -

Location(s) Clinic, Municipality, County Local churches, Nairobi, Nairobi City County; Kiambu County; Nyeri County

Partners Funding partners Fundraising (corporates, church, sponsors)

Collaborating partners Pax Romana, Queen of Apostles Catholic Church & Seminary, MOH Mathare District, FHOK, Halton Chemists, KENCO

Hospitals Neema Uhai Hospital, St. Francis Community Hospital, Zambezi Hospital, local hospitals

Universities Kenyatta University

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Lack of funds to purchase testing solutions

• Sponsors and donors

• Patient support

• Staff allowances (currently volunteer)

Non-financial • Lack of enough medical personnel related to cervical cancer

• Insufficient volunteers

• Limited working space

• Enormous numbers of women that register for screening

• Further checkups and referrals

• Time of the event

Data Source Name Boniface Mbiuki


Mode Via email


CDC: Centers for Disease Control and Prevention

Program Type U.S. Government Agency

Contacts Kisumu: Rebecca Lee Pethel, [email protected]

Nairobi: Wences Arvelo, [email protected], [email protected]

Atlanta: Natasha Buchanan, [email protected] (Cervical cancer assessment project); Allison Friedman (Girls HPV Vaccine project)

Duration 2013-2015, Research on-going

Activity Screening -

Treatment -

Training -

Outreach -

Other 1. Community KAB assessments regarding HPV Vaccine, cervical cancer screening, treatment and palliative care

2. IEC material development in conjunction with KEMRI & MOH

Equipment Screening equipment -


IEC materials Development of IEC materials in partnership with KEMRI, MOH, PS Kenya and partners

Other -

Location(s) Clinic, Municipality, County -

Partners Funding partners CDC

Collaborating partners KEMRI, MOH, PS Kenya, partners

Hospitals -

Universities -

Research Topic 1. Facilitators and barriers to HPV vaccine utilization by girls aged 9-12 (focus groups); informant interviews (community leaders/chiefs, traditional healers, providers, CHWs, media)

2. Factors to uptake of screening (multiple focus groups, including women and male partners -110 participants); informant interviews (community leaders/chiefs, traditional healers, providers, CHWs, media-10 in total); Discussion with referral hospitals as reported by women to understand cost of screening and treatment (5-6 in Nyanza; 8-10 in Nairobi)

Location 1. Nyanza Province (Siaya, Bondo)

2. Nyanza Province (Kisumu, Siaya, Bondo); Nairobi (12 districts)

# of participants 1. 60 women; 10 informant interviews

2. 110 focus group participants; 10 informant interviews; 5-6 Nyanza referral discussions; 8-10 Nairobi referral discussions

Status 1.Completed (2012-13); See Friedman et al. (2014)

2. Data collection completed (2013)/Project on-going (until 2015); Compiling data and preparing for publication

Partners 1. KEMRI, CDC-Kenya/Atlanta, MOH, U of Nairobi, U of Liverpool, local support

2. KEMRI, CDC-Kenya/Atlanta, MOH, U of Nairobi, local support

Challenges Financial -

Non-financial • Important NOT to do IEC materials without formative testing in each location where materials will be disseminated to ensure appropriateness, relevance, and overall efficacy.

• Need good on-the-ground project coordination

• Need effective community mobilization

• Important to engage community advisory boards (early and often) for engagement, review of materials/questions, recruitment)

• Make sure male leaders work with male groups, etc.

• Capture lessons learned from previous studies

Data Source Name Natasha Buchanan


Mode Via phone conversation


EARLY CANCER CARE AND DETECTION CENTER


Contacts Maureen Momanyi, [email protected]

Duration Since 2013

Activity Screening 2,600 total, 400 referred

Treatment -

Training -

Outreach Talks with community, churches, village chiefs

Other Translation of English-language materials to vernacular language

Equipment Screening equipment Locally sourced screening materials (speculum, vinegar, iodine, etc.)


IEC materials From other organizations

Other -

Location(s) Clinic, Municipality, County Kisii University, Jomo Kenyatta University, Nyamira County, Kisumu County, Siaya County

Partners Funding partners Fundraising, self-financed

Collaborating partners KENCO

Hospitals Local clinics

Universities Kisii University, Jomo Kenyatta University

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Lack of funding support

Non-financial • Client refusal

• Lack of supplies

• Lack of medical support/volunteers

• Lack of means of transport

• Quality of screening machines

Data Source Name Maureen Momanyi


Mode Via email


FACES: FAMILY AIDS CARE AND EDUCATION SERVICES


Contacts http://www.faces-kenya.org/

May Maloba

0720 254 069, [email protected], Reproductive Health Lead

Duration 2007-2011

(Future continuation will depend on funding)

Earch; 2012 roll out of cervical cancer program

Activity Screening Screening & treatment at six Nyanza facilities

Treatment See above

Training Training of providers (150) – included ‘champions’ who stayed in position for at least 2 years to train others

Outreach Outreach services (2 facilities – Mbita, Suba)

Other Discussions with KEMSA for continued medical supply support

Equipment Screening equipment Procured initial screening equipment

Treatment equipment 5 cryotherapy machines (Sindo, Rongo, Migori, Mbita, Lumumba)

1 LEEP (Lumumba HC)

IEC materials Flipcharts for CHWs; IEC materials for clients

Other -

Location(s) Clinic, Municipality, County Nyanza region (6 locations): Kisumu, Lumumba HC, Kisumu County; Mbita DH, Sindo DH, Homa Bay County; Migori DH, Rongo DH, Migori County; CRDR & Mimosa, Nairobi City County

Partners Funding partners CDC

Collaborating partners KEMRI, MOH, KEMSA

Hospitals Local health centers

Universities UC San Francisco

Research Topic Research (6 studies in HIV+ women, including safety around biopsy, etc.) – see Huchko et al 2014

Location

# of participants

Status

Partners

Challenges Financial • CDC withdrew support for CC screening, need to rely on GoK which lacks funds

• Need to pay for supplies out-of-pocket while negotiating with KEMSA

• No reliable sustainability system

Non-financial • Inconsistent screening services due to lack of funds for supplies

• Staff turnover to other facilities (need to re-train), makes it difficult to maintain pool of providers

• Competency of providers (need 2-3 years experience in see-and-treat – without consistent work, lose skills)

• Difficult to justify need to continue with the program (while #s show increase in CC and decrease in maternal mortality)

• Referral system challenges – JOOTRH cannot handle referrals, rely on MTRH/KNH/ Tenwek

• Lacking trained oncologist in Nyanza

• Referred patients either do not go, or do not continue with treatment (costs, other burdens) – services are inaccessible to people

Data Source Name May Maloba

Date 1 October 2014

Mode Via phone conversation


FHOK: FAMILY HEALTH OPTIONS KENYA


Contacts Jill Adhiambo: 0720.393.972, [email protected]

Esther Muketo: 0737.477.763, [email protected]

Duration N/A

Activity Screening Available at clinics

Treatment Cryotherapy in 4 counties

Training Training providers

Outreach Mapping CHWs to patients (with stipend)

Other Developing referral directory


Treatment equipment 7 cryotherapy machines

IEC materials -

Other -

Location(s) Clinic, Municipality, County Counties (11): Nairobi, Nakuru, Uasin Gichu, Kisumu, Kakamega, Meru, Nyeri, Thika, Mombasa, Kilifi, Kitengela

Partners Funding partners Gates Foundation

Collaborating partners PS Kenya, Marie Stopes International

Hospitals -

Universities -

Research Topic N/A

Location

# of participants

Status

Partners


Non-financial

Data Source Name Esther Muketo

Date 7 January 2015

Mode Cervical Cancer TWG meeting, 8 Oct 2013; via email


FARAJA CANCER SUPPORT TRUST


Contacts Shaira Adamali, [email protected],

Philip Odiyo, [email protected]

Duration Since 2012


Treatment -

Training -

Outreach Monthly cervical cancer support group meeting (avg. 10-20ppl/ month); Hospital outreach (pediatric)

Other Fundraising for patient support (treatment, etc.)



IEC materials In-house and UK IEC materials

Other -

Location(s) Clinic, Municipality, County Faraja Cancer Support Trust, CancerCare Kenya, Nairobi, Nairobi City County

Partners Funding partners Fundraising, Safaricom

Collaborating partners KENCO

Hospitals KNH

Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Cost of transport to come to meetings

Non-financial • Stigma

• Finding time to attend

• Should partner with other organizations to break down stigma associated with CC

Data Source Name Philip Odiyo


Mode Via email


HOPE BEYOND CANCER TRUST


Contacts Petronilla Maina, Trustee, [email protected]

Elizabeth Ragui, Trustee, [email protected]

Duration Since 2007 (originally named Reach To Recovery)

Activity Screening Screening (avg. 100-500 women per event)

Treatment Referral

Training Caregiver training in cancer support

Outreach Awareness campaigns

Other -



IEC materials Developed IEC materials in 5 local languages (through UICC)

Other -

Location(s) Clinic, Municipality, County Othaya, Nyeri County; Kajiado County; Machakos County; Nairobi City County; Kitui County; Naivasha, Nakuru County, Mumias, Kakamega County; Homa Bay County, Kiambu County; Murang’a County

Partners Funding partners Local fundraising

Collaborating partners KENCO, Local laboratories


Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Need to self-fund for each event

• Event organizers expect HBCT to provide all screening materials

Non-financial

Data Source Name Petronilla Maina

Date 2 October 2014

Mode Via email


ICAP: COLUMBIA UNIVERSITY


Contacts Dr. Lulu Oguda, 0702 210 497, [email protected]

Dr. Barasa 0733 546 568, 0722 419 651, [email protected]

Paulene 0722 820 208

Duration Since 2010

Activity Screening Screening for HIV-positive women (1,500/qtr)

Treatment Treatment (cryo, LEEP, referral)

Training Training in screening and treatment (100 HCWs)

Nurse training (21)

Reproduction and distribution of screening cards, visual inspection interpretation charts and registers to all sites

Outreach -

Other -

Equipment Screening equipment Screening kits

Treatment equipment Cryotherapy (10)

IEC materials IEC materials from partners

Other Data collection tools

Location(s) Clinic, Municipality, County • 5 ‘centers of excellence’ in Eastern South province: Machakos, Machakos County; Mwingi, Kitui, Kitui County; Makueni, Makindu, Makueni County

• 5 ‘centers of excellence’ in Nyanza province: Ahero, Nyakach, Kisumu County; Yala, Bondo, Siaya, Siaya County

• Referrals from other sites in Eastern South and Nyanza to the CoEs

Partners Funding partners PEPFAR, CDC

Collaborating partners MOH

Hospitals Local health centers

Universities U of Nairobi

Research Topic Future plans

Location -

# of participants -

Status -

Partners -

Challenges Financial • Sustainable funding for the program

Non-financial • Addressing issues with HIV-positive adolescents and adolescent sexual activity

• Quality of care at the facilities

Data Source Name Lulu Oguda

Date 6 October 2014

Mode Via email


JHPIEGO: TUPANGE PROJECT

Program Type International/Local collaboration

Contacts Tupange: Margaret Kilonzo, [email protected]

MCHIP: Catherine Ayuko, [email protected], 0722 678 982; Dr. Gathari Ndirangu, 0722 804 750, [email protected]

Duration Five year (2010-2015) – hoping for a second phase

Activity Screening Screening as part of family planning project outreach (43,909 total 2011-2014)

Treatment Referral to clinics for treatment

Training As part of family planning training

Outreach Community mobilization, logistical support

Other -

Equipment Screening equipment Speculums, Lugols iodine, Acetic acid, Cotton wool


IEC materials -

Other -

Location(s) Clinic, Municipality, County Nairobi City County; Kisumu East, Kisumu County; Mombasa Town, Mombasa County; Machakos municipality, Machakos County; Kakamega municipality, Kakamega County


Collaborating partners Consortium partners: Marie Stopes Kenya (private sector), Pharm Access Africa (commodity security), Center for Communication Program (demand creation), National Coordinating Agency for Population (advocacy)

Additional partners: National Council on Population and Development, Johns Hopkins U Center for Communication Programs, GoK

Hospitals -

Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Lack of family planning commodities, equipment

Non-financial • Service providers lack skills on long-term methods

• Staffing issues

• Quality issues

Data Source Name Margaret Kilonzo

Date 6 October 2014

Mode Via email


KENYA CANCER ASSOCIATION


Contacts Anne Korir, [email protected]

Duration 1995

Activity Screening Screening (Gatundu 200, Masiga 400, Nairobi 1500 with partners, Kangemi 100 with partners)

Treatment Referral

Training -

Outreach Cervical cancer education (monthly, 200-500 women reached)

Other -



IEC materials In-house IEC materials and from partners

Other -

Location(s) Clinic, Municipality, County Gatundu, Kiambu County; Masiga, Machakos County; Nairobi City County

Partners Funding partners Fundraising, donor funding (America Cancer Society), local donations – banks, well-wishers

Collaborating partners Aga Khan University Hospital- Oncology Program, MOH, Individual medical oncologists, Pharmaceutical industry, Other Patient advocacy groups


Universities -

Research Topic Developing a strategy for Integration of Non-Communicable Disease Education and Screening Services into existing HIV Testing and Counseling Centers in Nairobi, Kenya

Location Nairobi

# of participants Targeted 150 registered HTC centres and interviewed over 400 clients. Healthcare workers and decision makers were also interviewed

Status Data analysis stage

Partners America Cancer Society, County Government of Nairobi

Challenges Financial • The lack funds for further check up and treatment

• Cost of consumables for screening

Non-financial • The inability to access care by those found to be at risk or in early stage disease

• Lack of enough adequately trained nurses and doctors to conduct VIA/ VILLI

• Lack of cryotherapy equipment for on site treatment and intervention

Data Source Name Anne Korir

Date 8 October 2014

Mode Via email


MARIE STOPES KENYA


Contacts Michael Njuma, Deputy Director, Program Operations

[email protected], 0732 715 272

Elena Bonometti, Director (on maternity leave) [email protected]

Duration N/A

Activity Screening Screening and treatment through network of clinics (23/20 with cryo)

Treatment See above

Training Training for providers, including Social Franchise Network (200 providers trained)

Outreach Community mobilization and screening and treatment through mobile outreach teams

Other 14 mobile outreach teams – service 43 counties – free services – cervical cancer integrated into family planning

Equipment Screening equipment Screening supplies

Treatment equipment 20 Cryotherapy machines

IEC materials Through MOH (in development)

Other -

Location(s) Clinic, Municipality, County • MSK clinics in 15 counties

• Mobile outreach teams work in 43 counties

• Social franchise network (Amua) in 40 counties

Partners Funding partners Internal funding, Gates Foundation, KFW, Packard, EU, LAD, DFID

Collaborating partners Consortium with PS Kenya, FHOK; Social Franchise Network, MOH

Hospitals Marie Stopes clinics and external partners

Universities -

Research Topic Future plans through Marie Stopes International (MSI)

Location -

# of participants -

Status -

Partners -

Challenges Financial • Supplies – need central sourcing to ensure and reduce cost

Non-financial • Referral tracking system (trying to test follow up system options)

• Uncertainty about cryotherapy at public facilities (knowledge, functioning)

• Need to increase provider confidence and reduce cost-barrier – make screening more mainstream part of care

• Provider competencies

Data Source Name Michael Njuma

Date 7 October 2014

Mode Via phone


MINISTRY OF HEALTH: DIVISION OF REPRODUCTIVE HEALTH

Program Type Government of Kenya

Contacts Agnes Nakato, MD, [email protected]

Mary Gathitu, [email protected]

Clifton Katama, MD, (IEC lead) [email protected]

Duration Since 2011

Activity Screening Through MOH clinics

Treatment Through MOH clinics

Training Training – screening (2239), cryotherapy (173)

(Note: #s may overlap with implementing partner #s)

Outreach

Other HPV Vaccination Pilot – Kitui County (21,000 9-13yo girls & training service providers – 85% uptake) – support by GAVI, WHO, implementing partners, Dr. Nelly Mugo


Treatment equipment Distribution of cryotherapy (290); LEEP (#s unknown); Colposcopy (5); CECAP Protocols; CECAP data collection tools (in partnership with JHPIEGO)

IEC materials IEC Material development (on-going): in partnership with CDC, JHPIEGO, PS Kenya, other partners

Other Priority areas: training in screening and cryotherapy, improved reporting, procure additional machines

Location(s) Clinic, Municipality, County Goal to have Cryo machines in all 47 counties; Kitui County (Vaccine pilot)

Partners Funding partners GAVI Alliance, CDC, USAID, Gates Foundation

Collaborating partners Cervical Cancer Technical Working Group (implementing partners), APHIA Plus, UNFPA, UNICEF, Global Fund, WHO

Hospitals Public & private

Universities Various

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Funding – key partners are reducing funding

Non-financial • Community awareness/advocacy – lack of knowledge about screening

• Linking community to facilities

• Service provider skills & retention (including data collection)

• Equipment/supplies – lack of training and maintenance

• Inadequate treatment facilities

• Challenge disseminating CECAP tools through devolved health system

• Demand for vaccine

Data Source Name Agnes Nakato


Mode Meeting

Notes from Cervical Cancer TWG 8 Oct 2013

Email from Catherine Ayuko, JHPIEGO, 6 Oct 2014

Cryotherapy list (Appendix IV) from Dr. Nakato


PS KENYA

Program Type International/local NGO

Contacts Rachel Mutuku: 0736.860.249, Program manager, cervical cancer, [email protected]; Dana Tilson, [email protected]; Jobe: 0722.544.610

Duration 2012-2016 – possibly will extend, doing assessment now

Activity Screening Screening & treatment services (68,253/2014-up to Oct.)

Treatment Referral to public sector for advanced cases

Training Training on screening (75) and treatment (30)

Outreach Community outreach/mobilization

Other Development of IEC materials (in partnership with MOH)

Equipment Screening equipment Screening supplies

Treatment equipment Cryotherapy (25)

IEC materials In development (in partnership with MOH)

Other -

Location(s) Clinic, Municipality, County 300 clinics (social franchises) – 180 carry out screening/25 are treatment sights. Counties (21): Tana River, Kilifi, Kwale, Mombasa, Makueni, Embu, Meru, Kirinyaga, Nyandarua, Kiambu, Nairobi, Kajiado, Nakuru, Laikipia, Nandi, Vihiga, Kakamega, Bungoma, Busia


Collaborating partners Consortium with FHOK, Marie Stopes

MOH

Hospitals PS Kenya clinics, external partners

Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Long-term funding

Non-financial • Public sector referrals – cannot guarantee that machines are functioning

• Tracking patients for follow up treatment

• Need system strengthening (for referral, follow up)

• More community education & behavior change communication needed

• Stigma surrounding screening, treatment and disease

Data Source Name Rachel Mutuku

Date 6 October 2014

Mode Via phone


TREE: TREATMENT, RESEARCH AND EXPERT EDUCATION


Contacts Michael H. Chung, MD, Executive Director, www.tree4health.org, [email protected]; Fan Lee, Researcher, [email protected]; Elisabeth Vodicka, [email protected]

Duration Since 2006

Activity Screening Cancer screening: Pap (5300 in cervical dysplasia study); Coloposcopy, Colposcopy directed biopsy; VIA (2,000+ screened)

Treatment Cryotherapy (250+), LEEP (250+)

Training Training: Coptic Hospital (4), cervical dysplasia study (3) other research teams (3) (ie Dr. McClelland’s team)

Outreach -

Other -

Equipment Screening equipment HPV kit, speculums, cotton balls, forceps, cervix brush, acetic acid, colposcope and punch biopsy forceps

Treatment equipment Cryotherapy machine (1), cryotherapy probes, LEEP (1),

IEC materials -

Other -

Location(s) Clinic, Municipality, County Coptic Hope Center, Nairobi (2 centers), Nairobi City County; Maseno, Kisumu County

Partners Funding partners PEPFAR, U of Washington

Collaborating partners Coptic Mission, IARC, Fred Hutchinson Cancer Institute

Hospitals KNH, Coptic Hope Center

Universities U of Nairobi, U of Washington

Research Topic 1. Comparison of VIA, PAP and HPV testing to colposcopy-directed biopsy to determine which method is best to screen for cervical cancer in HIV-positive women

2. Analysis of presence of p16/Ki-67 biomarkers with ELISA to determine utility of these tests in cervical cancer screening in HIV-positive women

3. Comparison of cryotherapy and LEEP on recurrence of pre-cancerous lesions among HIV-positive women

4. Effect of cervical treatment on HIV shedding from the cervix

5. Qualitative research: Partner perceptions of cervical cancer

6. Cost analysis, quantification of methods, time/motion analysis

Location Coptic Hope Center & KNH (#6)

# of participants 1. 500; 2. 500; 3. 400; 4. 400; 5. Goal to enroll 20 couples, 10 males for focus groups; 6. N/A

Status 1.June – Nov 2009 (Chung et al 2013)

2. 2009 – Present (extension of above study)

3. 2011-current

4. 2011-current

5. 2014-current

6. On-going

Partners 1-5. Fred Hutchininson Cancer Research Center, IARC, Coptic Hospital, Kenyatta National Hospital, PEPFAR

6. Coptic Hospital, Kenyatta National Hospital, Lancet Labs, ICAP, KEMRI

Challenges Financial


TREE: TREATMENT, RESEARCH AND EXPERT EDUCATION - continued

Non-financial Program

• Limited personnel to conduct VIA at Hope Center

• Speculums – shared between Hope center and study clinic, we run out of clean speculums when there are many patients

• Quality of pathology reading – for pap smear cytology and biopsy histology

Research

• Suppy chain – process, coordination and sanitation of equipment

• Staff time

• Schedule organizating – patient interface

• Wait time for patients

• Lack of coordination of activities between partners

• Is it possible to somehow ‘quantify stigma’ in a systematic way in order to address it?

Data Source Name Elisabeth Vodicka, 26 September 2014, Via phone

Fan Lee, 26 September 2014, Via email

Date

Mode Additional: www.tree4health.org


UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Program Type US University

Contacts Megan Huchko, Craig Cohen (via Jennifer Smith)

Duration -


Treatment -

Training -

Outreach -

Other -



IEC materials -

Other -


Partners Funding partners -

Collaborating partners -

Hospitals -

Universities -

Research Topic Proposed: Comparison of implementation of care HPV testing (with self-collection) with referral to VIA; Leveraging existing data and randomization scheme, health fair access for dissemination of HPV testing kits

Location 12 communities, Nyanza Province, Kisumu County

# of participants Estimated eligibility of 18,000-20,000 women over 25

Status Proposed

Partners NIH, Gates Foundation, others, MOH


Non-financial

Data Source Name -

Date -

Mode Kenya HPVTesting document (J. Smith) 18 Nov 2013


UNIVERSITY OF MANCHESTER/CANCER RESEARCH TRUST-KENYA

Program Type International/Local collaboration

Contacts Dr Orora Maranga [email protected], Dr Ian Hampson [email protected]

Duration N/A

Activity Screening HPV testing & screening

Treatment Screening & treatment

Training -

Outreach -

Other -


Treatment equipment

IEC materials

Other

Location(s) Clinic, Municipality, County Nairobi, Nairobi City County

Partners Funding partners The Caring Cancer Research Trust

Collaborating partners The Cancer Prevention Research Trust, United in Cancer, Quest Cancer Research, The Charities Aid Foundation East Africa Medical Trust

Hospitals N/A

Universities University of Manchester

Research Topic Survival rate of Kenyan women with cervical cancer

Location Kenyatta National Hospital, Nairobi (Dept of Gynecology & Radiotherapy)

# of participants 355 women with cervical cancer, followed 2008-2010; 18% died during study; 42% did not complete treatment

Status Completed

Partners Hologic, Janice Cholerton Cancer & Postgraduate Studentship Fund, Humane Research Trust, IAEA, Wellbeing of Women


Non-financial

Data Source Name -

Date -

Mode University of Manchester (2013)

Maranga et al. 2013


UNIVERSITY OF NORTH CAROLINA/KEMRI-NAIROBI

Program Type International/local collaboration

Contacts Jennifer Smith, [email protected], +1919 966 7450

Nelly Mugo, MD, KEMRI

Duration -


Treatment -

Training -

Outreach -

Other -



IEC materials -

Other -




Hospitals -

Universities -

Research Topic CareHPV testing with triage to VIA for high-risk female sexual workers; Analysis of diagnostic performance over time

Location Nairobi

# of participants 350 high-risk female sexual workers [1/3 HIV-positive

Status On-going cohort study

Partners N/A


Non-financial

Data Source Name -

Date -

Mode Kenya HPVTesting document (J. Smith) 18 Nov 2013


UNIVERSITY OF NORTH CAROLINA/UNIVERSITY OF WASHINGTON

Program Type International/local collaboration

Contacts Jennifer Smith, [email protected], +1919 966 7450

Scott McClelland, [email protected]

Duration -


Treatment -

Training -

Outreach -

Other -



IEC materials -

Other -




Hospitals -

Universities -

Research Topic Comparison of care HPV testing with Genprobe APTIMA testing (self-collected) – technology is available to external partners to use; Comparison urine-based HPV test to swab self-collection; Comparison of screening methods (VIA, HPV, Pap); Fellowship exploring issues around vaccination of school-aged girls – facilitators and barriers

Location Mombasa

# of participants 600 stored samples from 200 female sexual workers – HIV-positive & -negative

Status Completed cross-sectional study; HPV testing on-going

Partners NIH

Challenges Financial

Non-financial • GoK support of bringing in materials – VAT tax issue

• Study not set up to support patients diagnosed with advanced cancer

• VIA/Cryo vs. biopsy (as done in the US)

• For those who may be ‘missed’, is there follow up counseling to advise continued testing?

Data Source Name Scott McClelland

Date 6 October 2014

Mode Meeting; additional info: Kenya HPVTesting document (J. Smith) 18 Nov 2013


WOMEN FOR CANCER EARLY DETECTION AND TREATMENT


Contacts Benda Kithaka, [email protected]

Duration Since 2012

Activity Screening Medical camps 2013-14 Total of 660 women

Treatment Referral to private/public facilities (negotiated discount rate)

Training -

Outreach Outreach talks (20+ in 2013, 25+ in 2014, reaching 600+ ppl); Social media campaigns

Other Support St Mary’s Clinic (Kibera) free screening (250 to date)

Equipment Screening equipment Screening kits (PAP kits), Single use disposable speculums


IEC materials In-house IEC materials

Other

Location(s) Clinic, Municipality, County Kiambu County; Machakos County; Kitui County; Nairobi County

Partners Funding partners Fundraising, Corporates

Collaborating partners GSK, Meridian Medical Centre, Civil society partners (KENCO)


Universities -

Research Topic -

Location -

# of participants -

Status -

Partners -

Challenges Financial • Our staff are all volunteers. This threatens our programme sustainability since we cannot afford dedicated resource to run with the day to day work.

Non-financial • We are faced with the ethical question of post diagnosis treatment. This is largely due to the prohibitive cost of treatment in Kenya.

• Lack of awareness coupled with myths and stigma on cervical cancer.

• Infrastructure and human expertise of resource in oncology.

Data Source Name Benda Kithaka

Date 9 October 2014

Mode Via email


Appendix I: References

Bansil P, Wittet S, Lim J, Winkler JL, Paul P, Jeronimo J. (2014) ‘Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach’, BMC Public Health, 14:596. doi:10.1186/1471-2458-14-596. Available from: http://www.biomedcentral.com/1471-2458/14/596.

Chung MH, McKenzie KP, De Vuyst H, Richardson BA, Rana F, Pamnani R, Njoroge JW, Nyongesa-Malava E, Sakr SR, John-Stewart GC, Mugo NR. (2013) ‘Comparing Pap Smear, VIA, and HPV Cervical Cancer Screening Methods among HIV-positive Women by Immune Status and Antiretroviral Therapy’, AIDS [e-pub]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23842133.

Chung MH, McKenzie KP, Richardson BA, John-Stewart GC, Coombs RW, De Vuyst H, Njoroge JW, Nyongesa-Malava E, Sakr SR, Mugo NR. (2011) ‘Cervical HIV-1 RNA Shedding after Cryotherapy among HIV-positive Women with Cervical Intraepithelial Neoplasia Stage 2 or 3’, AIDS, 25(15). Available from: http://www.ncbi.nlm.nih.gov/pubmed/21716072.

De Vuyst H, Chung MH, Baussano I, Mugo NR, Tenet V, van Kemenade FJ, Rana FS, Sakr SR, Meijer CJ, Snijders PJ, Franceschi S. (2013) ‘Comparison of HPV DNA testing in cervical exfoliated cells and tissue biopsies among HIV-positive women in Kenya’, International Journal of Cancer. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23444059.

De Vuyst H, Mugo NR, Chung MH, McKenzie KP, Nyongesa-Malava E, Tenet V, Njoroge JW, Sakr SR, Meijer CJLM, Snijders PJF, Rana FS, Franceschi S. (2012) ‘Prevalence and Determinants of Human Papillomavirus Infection in HIV-positive Women in Nairobi, Kenya’, British Journal of Cancer, 107(9), pp.1624-30. Available from: http://www.nature.com/bjc/journal/v107/n9/abs/bjc2012441a.html.

Friedman et al. (2014) ‘Preparing for human papillomavirus vaccine introduction in Kenya: implications from focus-group and interview discussions with caregivers and opinion leaders in Western Kenya’, BMC Public Health, 14, p.855-865. Available from: http://www.biomedcentral.com/1471-2458/14/855 (Accessed 26 September 2014).

Hatcher, J. (2014) ‘Kenyan girls get cervical cancer vaccine but women’s wait for treatment goes on’, The Guardian [Online]. Available from: http://www.theguardian.com/global-development/2014/feb/17/kenya-cervical-cancer-treatment-vaccine.

Huchko, MJ, Sneden, J, Leslie HH, Abdulrahim N, Maloba M, Bukusi E, Cohen CR. (2014) ‘A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya’, Bulletin of the World Health Organization, 92:195-203. Available from: http://www.who.int/bulletin/volumes/92/3/13-122051/en/.

ICAP. (2013) ICAP Scales Up Cervical Cancer Screening Programs in Mozambique, Tanzania and Kenya [Online]. Available from: http://icap.columbia.edu/news-events/detail/icap-scales-up-integrated-cervical-cancer-screening-programs-in-mozambique (Accessed 23 September 2014).

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