Litvin, Kate

School of Public Health

MSPH

Botswana

CDC Cervical Cancer Prevention Program

Cervical cancer, caused by the Human Papilloma Virus (HPV), is the leading cause of cancer mortality as well as the most frequent cancer among women in Botswana, accounting for nearly a quarter of all female cancers in Botswana. The HIV epidemic is a major factor driving this high burden of cervical cancer, as the risk for developing cervical cancer in women infected with HIV is increased three- to six-fold compared to HIV negative women. In addition, cervical cancer progresses more aggressively in HIV infected women.

Jhpiego, working with the Ministry of Health (MOH) and with funding from the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control (CDC) and Pink Ribbon Red Ribbon (PRRR), in July 2015 initiated a five year project entitled "Capacity Building through Training and Mentoring for Cervical Cancer" in Botswana under the President's Emergency Plan for AIDS Relief (PEPFAR). The program aims to support the MOH and Government of Botswana (GOB) to significantly scale up capacity in cervical cancer prevention (CECAP), screening and treatment with a vision that by the end of this project, the majority of women aged 30-49 years and at least 80% of sexually active women with HIV will have access to screening for cervical cancer and treatment for abnormal results; and at least 80% of all girls 9-13 years in the targeted areas will have access to primary prevention with HPV vaccination. Implementation is aligned with PEPFAR's geographic prioritization within PEPFAR's 11 priority districts and 63 priority facilities. Jhpiego provides support at MOH facilities providing cervical cancer screening through visual inspection with acetic acid (VIA) and same day treatment with Cryotherapy, known as “See and Treat” services in Botswana.   Jhpiego's work focuses on strengthening of the capacity of the national cervical cancer program, scaling up primary and secondary prevention services, and developing a sustainable platform for long term service provision.

Currently, the "See and Treat" programs operate with MOH staff at MOH sites in six districts. Since program inception in 2012, more than 10,000 women have been screened for cervical cancer, more than 3,000 treated for cervical cancer. As the MOH's National Cervical Cancer Prevention Program (NCCPP) takes on an increasing number of activities and responsibilities as cervical cancer activities expand nationally, support within NCCPP is greatly needed.
The JHU Intern will work with the Jhpiego CECAP program team, especially the monitoring and evaluation team, to support targeted operations research, data collection and analysis, and development of evidence to identify program successes.

Global Health Mentor/PI: Alisa Smith-Arthur | Jhpiego

Living and working in Botswana from July to October was a chance to experience working on program implementation with an international NGO and also the real-world challenges of global health. I arrived in Gaborone—the capital of Botswana—in early July, the middle of the winter season in Botswana, and promptly discovered cold weather in sub-Saharan Africa is no joke. I unexpectedly relied on my space heater and single warm sweater and coat almost every day during my first month in Botswana.

This internship was a chance to learn about implementation of a national health services program in collaboration with the Ministry of Health. Although I have previously worked in community health and AIDS prevention as a Peace Corps volunteer in Togo, West Africa, and managed monitoring and evaluation for an oncology association in Alexandria, Virginia, my established field placement was a great opportunity to experience program management. Working closely with the technical lead for scale-up for the national cervical cancer prevention program, I observed the real world realities of managing staff, supplies, training programs, data collection and national coordination. This summer internship with Jhpiego reinforced my desire to pursue a career in the implementation and management of global health programs.

Living in Botswana is very different from many people’s conceptions of life in Africa. In fact, the World Bank recently announced Botswana to be a middle-income country and the capital resembles a medium-size city in the United States in many ways. I discovered the abundance of shopping malls, coffee shops and even movie theaters with familiar films. My housing had all the comforts of home—air conditioning and heating, wireless Internet, cable TV—and even comforts I was not used to—like a housecleaner and pool! My office also resembled a corporate environment in the United States and some of my coworkers dressed more professionally and stylishly than in the typical non-profit environment back home. However, there were definitely aspects of life that reminded me: I am living in Africa. I bought my lunch every day from a women selling local cuisines form a stall across the street, and developed a taste for “samp” and “pap,” starchy and tasty foods served with meat and veggies on the side. For my commute to the office, I took the local minibus called a “combi,” which was always a tightly packed ride with 15 other people. To indicate my stop, I would shout to the driver in the local language, Setswana, and navigate my way out of the van. Even on the major roads, drivers had to navigate around the cattle and goats wandering across the street, and brave cyclists pedaled along the dusty streets.

However, access to health services differs greatly for people living in the capital and people living in the remote villages. The majority of people in Botswana live in rural areas and rely on farming and cattle-raising for income. These populations have to travel a greater distance to reach a heath clinic, and may need to come all the way to the capital for specialized heath services such as cancer diagnosis and treatment. My project, working on the scale-up of cervical cancer prevention, aimed to increase women’s access to cervical cancer screening by training nurses to perform a low-cost, effective method called VIA. Jhpiego and Ministry of Health worked together to train nurses how to perform the screening method and offer same-visit treatment with cryotherapy. In my internship, I was able to participate in a training of new providers in Francistown, and I provided logistical and technical assistance for the training. The nurses learned these skills through a combination of classroom time and practical experience providing free screening and treatment during a week of clinic days: more than 60 women from the surrounding communities came each day for free care. Not only was this an important opportunity to increase the proportion of women in Botswana screened for cervical cancer, but also I was able to speak with some of the clients and document their stories to share with Jhpiego’s main office and donors.

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