Integrating Cervical Cancer Services into HIV Treatment and Care Activities in Zambia

USAID DISCOVER-Health provides reproductive, maternal, and family planning services, including cervical cancer screening and treatment, to its female clients. A service provider with a client. Photo: Jason Mulikita

By James Mwanza and Syrga Kanatbek kyzy

In addition to contributing to HIV epidemic control in Zambia, the USAID DISCOVER-Health Project is also meeting a vital need to intensify and scale up cervical cancer services in communities. The project works closely with the Ministry of Health’s outreach clinics and sites to provide not only HIV treatment and care but also integrated reproductive, family planning, maternal, and child health services and products.

The Most Common Cancer among Women in Zambia

Cervical cancer is the most common cancer among women between the ages of 15 and 44 years in Zambia (1). In the region, it is the leading cause of cancer deaths among women, the highest in the world (2). Women who live with HIV (which in Zambia is 21 percent of those 15–49) (3) and human papillomavirus (HPV) are three times more likely to progress to invasive cervical cancer.

Cervical cancer can be prevented by vaccination at an early age and screening and treatment.

HPV vaccination is primary prevention and once fully vaccinated, girls are protected from acquiring HPV and progressing to cervical cancer,” says James Mwanza, a hub manager on the USAID DISCOVER-Health Project in Chingola, Zambia.

However, James and his team are challenged by vaccination myths and misconceptions and a lack of accessible public information and appropriate provider training. As a result, “Parents refuse to give consent to have their girls vaccinated. Women shun screening. Sometimes, even if some parents give consent, girls refuse the HPV vaccine,” he says.

Prevention through Community Awareness

Cervical cancer awareness and HPV vaccination are primary prevention for girls 9–14 years. The project involves community care volunteers who advocate the value of vaccines and screening. Faith Nkhoma, a midwife at the USAID DISCOVER-Health-supported Kings Health Post, recalls a recent campaign to convey information about the vaccine to the girls and their parents and teachers.

Heading into the community was a successful way of carrying out the campaign, rather than expecting people to come to us at the clinic,” says Faith.

Zambia subscribes to the 90-70-90 targets the World Health Organization set for cervical cancer reduction in the next century. These call for fully vaccinating 90 percent of girls with the HPV vaccine by age 15; screening 70 percent of women by age 35, and again by age 45; and treating 90 percent of women who have HPV. The project focuses on the 70-90 target and prioritizes activities for women and adolescents living with HIV. A dedicated team of cervical cancer care providers ensure that all women ages 15–45 who receive HIV treatment and care through the project are screened for cervical cancer annually. The providers work with community health care workers who promote the project’s HIV treatment program so they seek this service annually. Providers screen women visually using the acetic acid (VIA) method, an inexpensive life-saving methodology. Between 2018 and January 2024, the team screened 57,756 women living with HIV.

Another activity that James and his team focus on is training staff in cervical cancer screening so that the service can be sustained when the project transitions its services to the Ministry of Health. Service providers also learn to identify and refer advanced cases to higher-level facilities and follow them up.

[These] trained health care workers are trusted figures. They are a regular and familiar source of information, especially for women living with HIV,” says Faith.

Making Progress toward Prevention

“Sensitization of women about this cancer type is critical to reduce country-specific mortality,” says James. The project plans to scale up sensitization activities on HPV vaccination for 9–14-year-olds and integrate youth-friendly services in remote areas. These activities will enhance cervical cancer prevention, early detection, and treatment with the ultimate goal of preventing mortality.

Learn more about JSI’s work on the USAID DISCOVER-Health Project. JSI has worked with over 13 countries to plan, implement, and monitor HPV vaccination programs. Now, JSI and partners lead the HPV Vaccine Acceleration Program Partners Initiative Consortium, funded by the Bill & Melinda Gates Foundation. The consortium provides technical assistance for accelerated HPV vaccine introduction, stakeholder engagement, evidence-based decision-making, and coverage improvement.

1.  HPV Information Centre, Human Papillomavirus and Related Diseases Report, 2023.
2. Yang, L et al, Regional and country-level trends in cervical cancer screening coverage in sub-Saharan Africa: A systematic analysis of population-based surveys (2000–2020), 2023.
3. Trejo J.M et al, Effects of HIV infection on metastatic cervical cancer and age at diagnosis among Patients in Lusaka, Zambia. 2022.