Cervical cancer impacts over half a million women globally each year, with almost 90% of cases occurring in resource-limited settings. This is mainly due to the lack of population-based screening programs, which reduce the burden of disease in resource-replete settings through treatment of precancerous lesions. In sub-Saharan Africa, the cervical cancer disparity has worsened over the past twenty years due to the HIV epidemic, which increases the biologic risk for cervical cancer and has strained the already overburdened healthcare systems. In Uganda, the Ministry of Health has set an agenda for cervical cancer prevention over the next 5 years. It recognizes that in addition to employing evidence-based screening and treatment techniques, the overall population impact of cervical cancer screening depends on two main factors: (1) community-wide access to screening and (2) successful linkage to treatment or follow-up for women who screen positive. In Research Project 2, the Uganda-UCSF Consortium will evaluate a context-specific, community-based cervical cancer prevention program employing simple, low-cost screening and treatment techniques. Specifically, the program will provide cervical cancer screening with self-collected human papillomavirus (HPV) specimens offered through community health campaigns. The program will also provide cryotherapy through mobile treatment teams working in the local communities to reduce the risk of invasive cancer in women who test positive for HPV. Ongoing evaluation of the program will allow the research team to iteratively adapt the activities to address individual- and community-level factors.as well as processes that impact the uptake of screening and treatment.
The specific aims are to:
Aim 1 : Establish the acceptance and correlates of self-collected HPV-RNA testing among women in the rural Ugandan community as well as the incidence and determinants of successful completion of the cervical cancer screening cascade from self-collected IHPV testing to receipt of results Aim 2: Ascertain the frequency and determinants of successful acquisition of treatment among women who have HPV detected on self-collected swabs in rural Uganda.
Aim 3 : Derive population-based estimates of the prevalence of high-risk HPV and cervical intraepithelial neoplasia (CIN) detected through community-based screening employing self-collected HPV RNA testing in rural Uganda.

Public Health Relevance

Cervical cancer disproportionately impacts women in resource-limited settings, due to lack of screening programs. This research will address the context-specific factors necessary for the implementation of an effective screening and treatment program. It will have an immediate impact on women's health in Uganda by identifying and treating women at risk for cancer.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZCA1-RPRB-O (M2))
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Dominguez, Geraldina
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University of California San Francisco
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