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Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 199 p.The Trainees’ handbook is designed to train gynaecologists and non-specialist clinicians in performing colposcopy and treatment of cervical precancerous conditions so they can provide the necessary diagnostic and therapeutic services in a cervical cancer screening programme. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training programme on cervical cancer screening and treatment. The Trainees’ handbook contains different modules intended to assist trainees to develop their knowledge and learn the correct steps to perform colposcopy and treatment procedures. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. The structure and methodology of the training have been designed to impart knowledge in the most effective manner and have taken into consideration the overall training objectives, profiles of trainees and the expected learning outcomes. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 118 p.This manual is an instruction guide for facilitators to provide competence based training to providers of colposcopy and treatment services in a cervical cancer screening programme. The training is intended to assist gynaecologists and non-specialist clinicians to learn and improve upon their skills to perform colposcopy and to treat cervical pre-cancers by excision methods. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training participants through interactive presentations, group discussions, role plays, clinical practice sessions, etc. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions and guidelines for assessment of trainees. The Trainees’ handbook contains different modules to assist trainees with step-by-step learning of colposcopy and treatment procedures. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Trainees' handbook.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 171 p.The Trainees’ handbook is designed for paramedical workers, midwives, nurses and clinicians involved in cervical cancer screening to help them acquire the necessary skills to perform VIA, collect samples for HPV test and treat cervical pre-cancers by ablative methods. The publication of the World Health Organization guidance document Comprehensive cervical cancer control: A guide to essential practice, 2nd edition, 2014 has necessitated modifications in the existing training resources for cervical cancer screening and treatment. The new screening recommendations and management algorithms have been incorporated in the present Trainees’ handbook. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training on cervical cancer screening and treatment. The handbook contains different modules to assist trainees to learn various screening and treatment procedures step- by-step and to comprehend their underlying principles. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Facilitators' guide.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 123 p.This manual is an instruction guide for facilitators to provide competence based training to providers for screening (with VIA or HPV test) and ablative treatment services in a cervical cancer screening programme. The training is intended to assist midwives, paramedical workers, nurses and clinicians to learn and improve upon their skills to perform counselling, screening tests and treatment. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training through interactive presentations, group discussions, role plays, simulated learning sessions, and clinical practice sessions. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions, simulated learning sessions and guidelines for assessment of trainees. (Excerpt)
Cervical cancer screening and management of cervical pre-cancers. Training of community health workers.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 92 p.The training manual is designed to assist in building capacity of community health workers (CHWs) in educating women and community members on relevant aspects of cervical cancer prevention. The manual aims to facilitate improvement in communication skills of CHWs for promoting uptake of cervical cancer screening services in the community. The primary intention of this manual is to assist CHWs in spreading community awareness on cervical cancer prevention and establishing linkage between the community and available screening services. The information and instructions included in the manual can be used by both the facilitators and CHWs while participating in the training. The manual contains nine different sessions to assist CHWs to be acquainted with different aspects of cervical cancer prevention at the community level with focus on improving their communication skills. Each session contains key information in ‘question and answer’ format written in simple language so that CHWs can comprehend the contents better. At the end of each session, there are group activities like role plays, group discussion and games for active learning. These are intended to give opportunity to CHWs to learn by interacting with each other and also relate themselves with their roles and responsibilities at the community level. The manual includes ‘notes to the facilitator’ on how to conduct various sessions as per the given session plan. A set of ‘Frequently Asked Questions’ has been included to help the CHWs provide appropriate information to women and community members.
Cervical cancer screening and management of cervical pre-cancers. Trainees' handbook and facilitators' guide - Programme managers' manual.
New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 145 p.The training manual for programme managers is designed to build the capacity of professionals in managerial positions to develop cervical cancer screening programmes, plan implementation strategies and effectively manage the programme at the national or sub national levels. The guidelines and information included in the manual are intended to be used both by trainees and facilitators while participating in the structured training programme for programme managers. The manual contains different modules to assist trainees to be acquainted with different aspects of planning, implementing and monitoring of cervical cancer screening services. Considering the fact that programme managers need to understand cervical cancer screening in the broader perspective of the national cancer control programme (NCCP), modules describing the planning and implementation of NCCP are also included in the manual. The modules include relevant case studies from real screening programmes in different countries. The manual includes notes to facilitators on how to conduct the various training sessions as per the session plan. The detailed methodology of conducting trainee evaluation is also part of this manual.
Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study.
BMC Cancer. 2017 Nov 25; 17(1):791.BACKGROUND: Where resources are available, the World Health Organization recommends cervical cancer screening with human papillomavirus (HPV) DNA testing and subsequent treatment of HPV-positive women with timely cryotherapy. Newer technologies may facilitate a same-day screen-and-treat approach, but these testing systems are generally too expensive for widespread use in low-resource settings. METHODS: To assess the value of a hypothetical point-of-care HPV test, we used a mathematical simulation model of the natural history of HPV and data from the START-UP multi-site demonstration project to estimate the health benefits and costs associated with a shift from a 2-visit approach (requiring a return visit for treatment) to 1-visit HPV testing (i.e., screen-and-treat). We estimated the incremental net monetary benefit (INMB), which represents the maximum additional lifetime cost per woman that could be incurred for a new point-of-care HPV test to be cost-effective, depending on expected loss to follow-up between visits (LTFU) in a given setting. RESULTS: For screening three times in a lifetime at 100% coverage of the target population, when LTFU was 10%, the INMB of the 1-visit relative to the 2-visit approach was I$13 in India, I$36 in Nicaragua, and I$17 in Uganda. If LTFU was 30% or greater, the INMB values for the 1-visit approach in all countries was equivalent to or exceeded total lifetime costs associated with screening three times in a lifetime. At a LTFU level of 70%, the INMB of the 1-visit approach was I$127 in India, I$399 in Nicaragua, and I$121 in Uganda. CONCLUSIONS: These findings indicate that point-of-care technology for cervical cancer screening may be worthy of high investment if linkage to treatment can be assured, particularly in settings where LTFU is high.
Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:63-68.The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should assess their readiness and conduct careful planning, taking into consideration potential obstacles. International organizations can catalyze action by helping governments overcome initial barriers to scale-up. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:57-62.Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. Failure to launch or expand cervical cancer prevention programs is by and large due to the absence of dedicated funding, along with a lack of recognition of the urgent need to update policies that can hinder access to services. Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Geneva, Switzerland, WHO, 2016. 64 p.This report is a companion to the World Health Organization’s 2016 guide for “Introducing HPV Vaccine Into National Immunization Programmes.” It summarizes experiences introducing HPV vaccine and provides guidance for introduction.
Geneva, Switzerland, WHO, EPI, 2016. 104 p.This document is intended for use by national immunization programme managers and immunization partners to inform the policy discussions and operational aspects for the introduction of HPV vaccine into national immunization programmes and to provide up-to-date references on the global policy, as well as the technical and strategic issues related to the introduction of HPV vaccine.
The Cervical Cancer Prevention Initiative: Investing in Cervical Cancer Prevention 2015–2020. Year One update, November 2016.
[Seattle, Washington], PATH, 2016 Nov. 7 p.It has been a year since the groundbreaking meeting in London where the Cervical Cancer Prevention Initiative was launched. This short report documents progress building the Initiative over the past 12 months, and lists key global milestones in cervical cancer during that time.
World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer.
International Journal of Gynaecology and Obstetrics. 2016 Mar; 132(3):252-8.BACKGROUND: It is estimated that 1%-2% of women develop cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) annually worldwide. The prevalence among women living with HIV is higher, at 10%. If left untreated, CIN 2-3 can progress to cervical cancer. WHO has previously published guidelines for strategies to screen and treat precancerous cervical lesions and for treatment of histologically confirmed CIN 2-3. METHODS: Guidelines were developed using the WHO Handbook for Guideline Development and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. A multidisciplinary guideline panel was created. Systematic reviews of randomized controlled trials and observational studies were conducted. Evidence tables and Evidence to Recommendations Tables were prepared and presented to the panel. RESULTS: There are nine recommendations for screen-and-treat strategies to prevent cervical cancer, including the HPV test, cytology, and visual inspection with acetic acid. There are seven for treatment of CIN with cryotherapy, loop electrosurgical excision procedure, and cold knife conization. CONCLUSION: Recommendations have been produced on the basis of the best available evidence. However, high-quality evidence was not available. Such evidence is needed, in particular for screen-and-treat strategies that are relevant to low- and middle-income countries. Copyright (c) 2015. Published by Elsevier Ireland Ltd.
Geneva, Switzerland, WHO, 2014.  p.This publication, Comprehensive cervical cancer control: a guide to essential practice (C4GEP), gives a broad vision of what a comprehensive approach to cervical cancer prevention and control means. In particular, it outlines the complementary strategies for comprehensive cervical cancer prevention and control, and highlights the need for collaboration across programmes, organizations and partners. This new guide updates the 2006 edition and includes the recent promising developments in technologies and strategies that can address the gaps between the needs for and availability of services for cervical cancer prevention and control.
MMWR. Morbidity and Mortality Weekly Report. 2015 Feb 20; New Delhi, India, WHO, Regional Office for South-East Asia, 2015. 64(6):137-140.  p.The overall objective of the strategic framework for comprehensive control of cancer cervix in South-East Asia is to guide and assist Member States to develop or strengthen national strategies to improve cervical cancer control activities; to reduce the burden of morbidity, disability and death from cervical cancer; and, to promote women’s health. The specific objectives of the framework are to help countries to prepare country-specific protocols to: 1. Introduce or scale up delivery of HPV vaccine to girls aged 9 to 13 years through a coordinated multisectoral approach involving national immunization, cancer control, reproductive and adolescent health programmes. 2. Implement or scale up organized cervical cancer screening programmes utilizing evidence-based, cost-effective interventions through effective service delivery strategies across the different levels of health care. 3. Strengthen health systems to ensure equitable access to cervical cancer screening services for all eligible women, with particular attention to socioeconomically disadvantaged population groups. 4. Augment management facilities for invasive cancer cervix and introduce palliative care services into the health system as part of a comprehensive cancer control programme. 5. Encourage / create convergence with related health programmes to ensure a coordinated and operationally feasible approach for cervical cancer control within the health system. 6. Initiate / augment a structured and coordinated advocacy and educational campaign so that the benefits of cervical cancer control are universally available and accessible. The framework discusses the determinants of a successful and organized screening programme, and feasible options that the countries can adopt. It recommends that cervical cancer screening services should be organized as a functional continuity across different levels of health-care delivery, from community to first-level health centres and to referral hospitals, so as to ensure high coverage of the target population and linkage between screening and treatment. Augmentation of cancer treatment services and improving palliative care are also crucial components of cervical cancer control that are discussed in the framework. (Excerpts)
Geneva, Switzerland, WHO, 2013.  p.These WHO guidelines provide recommendations for strategies for a cervical precancer screen-and-treat program. The guidelines build on previous documents: Use of cryotherapy for cervical intraepithelial neoplasia (published in 2011) and on the new WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and glandular adenocarcinoma in situ. The document is intended primarily for policymakers, managers, program officers, and other professionals in the health sector who have responsibility for choosing strategies for cervical cancer prevention at country, regional and district levels.
Monitoring national cervical cancer prevention and control programmes: quality control and quality assurance for visual inspection with acetic acid (VIA)-based programmes.
Geneva, Switzerland, WHO, 2013.  p.This guide outlines quality control (QC) and quality assurance (QA) considerations to support introduction or scale-up of visual inspection with acetic acid (VIA) as a screening test for cervical cancer, within the context of national comprehensive cervical cancer prevention and control programmes. The guide proposes a framework for QC and QA including a core set of indicators, and provides examples for how the indicators can be set, measured and used to strengthen programme implementation. The guide is intended primarily for programme managers, supervisors and other stakeholders working in public health programmes for cervical cancer prevention and control.
Geneva, Switzerland, WHO, 2013.  p. (WHO Guidance Note)This WHO Guidance Note advocates for a comprehensive approach to prevention and control of cervical cancer and is aimed at senior policymakers and program managers. It describes the need to deliver effective interventions across the female lifespan. These interventions include community education; social mobilization; HPV vaccination; and cancer screening, treatment, and palliative care. The document outlines complementary strategies for comprehensive prevention and control, and it highlights collaboration across national health programs (particularly immunization, reproductive health, cancer control and adolescent health), organizations, and partners.
Exchange. 2009; (3):14-15.Male circumcision is common in the Asia region, with high prevalence noted in eight out of 27 South and Southeast Asian and Pacific Island countries. Bangladesh, Indonesia, Pakistan and the Philippines have the highest number of circumcised men, estimated at 120 million. In these countries, circumcision is primarily for religious and cultural reasons with the exception in the Republic of Korea and the Philippines where circumcision is routine and widespread and with no linkages to religion.
Symposium proceedings. HPV Vaccines: New Tools in the Prevention of Cervical Cancer and Other HPV Disease in Asia and the Pacific, Bangkok, Thailand, 2 November 2006.
Bangkok, Thailand, Family Health International [FHI], Asia / Pacific Regional Office, 2007. 55 p.Cervical cancer -- the most preventable and treatable of all cancers -- is the most common cancer among women in developing countries. This report presents the proceedings of a November 2006 symposium organized by FHI in Bangkok, Thailand, that brought together leading specialists in immunization, cancer prevention, and other disciplines to start building consensus on a comprehensive approach to programming for the prevention and early detection of cervical cancers in the Asia region. Presentations covered such topics as improved screening methods for cervical cancer, the latest research on human papillomavirus (HPV) vaccines, and country and social perspectives related to HPV vaccination. Participants concluded that there is a need to 1) further educate health professionals, especially so they can influence policymakers and service planners, and 2) devise communication strategies that will shape debates on HPV vaccines.
Archives of Gynecology and Obstetrics. 2007 Dec; 276(6):583-589.The objective was to evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. The mean age of the participants was 56.8 plus or minus 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL. (author's)
Human papillomavirus and HPV vaccines: technical information for policy-makers and health professionals.
Geneva, Switzerland, WHO, 2007. 36 p. (WHO/IVB/07.05)Cervical cancer is the most common cancer affecting women in developing countries. It has been estimated to have been responsible for almost 260 000 deaths in 2005, of which about 80% occurred in developing countries. Cervical cancer is caused by human papillomavirus (HPV). Recently a vaccine that has the potential to prevent certain HPV infections, and hence reduce the incidence of cervical cancer and other anogenital cancers, has been licensed. Another vaccine is in advanced clinical testing. This document provides key information on HPV, HPV-related diseases and HPV vaccines, and is intended to underpin the guidance note on HPV vaccine introduction, recently produced by WHO and the United Nations Population Fund (UNFPA). HPV are DNA viruses that infect skin or mucosal cells. There are more than 100 known HPV genotypes, at least 13 of which can cause cancer of the cervix and are associated with other anogenital cancers and cancers of the head and neck; they are called "high-risk" genotypes. The two most common of these (genotypes 16 and 18) cause approximately 70% of all cervical cancers. HPV (especially genotypes 6 and 11) can also cause genital warts, a common benign condition of the external genitalia that causes significant morbidity. HPV is highly transmissible, with peak incidence of infection soon after the beginning of sexual activity. Most people acquire the infection at some time in their life. Factors contributing to development of cervical cancer after HPV infection include immune suppression, multiparity, early age at first delivery, cigarette smoking, long-term use of hormonal contraceptives, and co-infection with Chlamydia trachomatis or Herpes simplex virus. (excerpt)
Integrating sexual health interventions into reproductive health services: programme experience from developing countries.
Geneva, Switzerland, World Health Organization [WHO], 2005.  p. (Sexual Health Document Series)In 1994, at the International Conference on Population and Development (ICPD, 1994), 184 countries reached a landmark consensus on the need for a broad, integrated approach to sexual and reproductive health. Since that time, countries have been struggling to put the concept into practice. The first challenge has been to understand the broad concept of sexual and reproductive health, in order to identify the service interventions that should be added to an existing reproductive health (RH) or maternal and child health (MCH) programme to make it a sexual and reproductive health (SRH) programme. The second, more difficult, challenge has been to develop feasible, acceptable and cost effective strategies for providing these services within the existing, poorly resourced, primary health care programme base. To create SRH programmes, reproductive health services have to be expanded to better address sexual health. SRH programmes need to give attention to broader determinants of healthy sexuality and well-being. A recent WHO publication, Conceptual framework for programming in sexual health, offers a sexual health approach to service design and implementation. It stresses the need to recognize that not all sexual activity is for reproduction, and that other motivational factors, such as pleasure or a sense of obligation, are often more important determinants of individual sexual health and well being. To improve sexual health, programmes must address sexuality throughout the lifespan, from adolescence to old age, for both men and women. They must also recognize the role of power in sexual relationships and how it affects people's ability to make decisions about their own bodies and sexual life, free from violence, discrimination and stigma. Individual decision-making and the ability to make informed choices can also be limited by social, cultural and legal barriers. Broad sexual and reproductive health care services must recognize and begin to address these constraints through targeted interventions. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2006.  p.This guidance note is based on a UNFPA/WHO Technical Consultation on HPV Vaccines and Sexual and Reproductive Health Programmes, held in March 2006 in Montreux, Switzerland. It is intended to alert a broad array of stakeholders -- in sexual and reproductive health, immunization, child and adolescent health, and cancer control programmes -- to some of the key issues surrounding the upcoming introduction of HPV vaccines against cervical cancer. In particular, it highlights the contributions that national immunization programmes, sexual and reproductive health programmes, and cancer control programmes can make in preparing for national introduction of the vaccines in the context of the Global Immunization Vision and Strategy. (excerpt)
Lancet. 2006 Apr 22; 367(9519):1299-1300.Merck's vaccine for cervical cancer is being reviewed as a priority by the US Food and Drug Administration (FDA), with a ruling due on June 8, and GlaxoSmithKline submitted an application for its vaccine in the European Union on March 9. The issue of how best to introduce these vaccines to young people before they become sexually active is now, therefore, a research priority. Vaccination against cervical cancer is especially important in developing countries, where nearly 80% of cases are reported and where effective methods of diagnosis--such as the Pap smear--are rarely used. Modelling studies indicate that vaccines against human papillomavirus (HPV) could be effective in preventing cervical cancer provided all adolescents--not just those at high risk--are vaccinated before they become sexually active. The need to reach large numbers of adolescents with a series of three injections is a challenge, however, especially in sub-Saharan Africa. (excerpt)