New treatment option saves women from cervical cancer

Mariam Cissé is a mother of three and living with HIV but when she arrived at Treichville Teaching Hospital in Abidjan, Ivory Coast, she was not expecting news that would cause her to fear for her life.

The story of Mariam Cisse first appeared on the PEPFAR website.

Mariam Cissé is a mother of three and living with HIV but when she arrived at Treichville Teaching Hospital in Abidjan, Ivory Coast, she was not expecting news that would cause her to fear for her life.

A year earlier she had been screened for cervical cancer using a technique called visual inspection with ascetic acid (VIA). The doctor had found no abnormalities and Mariam had gone back to caring for her family and working as a market trader near Abidjan.

When Mariam returned for her routine visit a year later she was told she had a large lesion on her cervix – too large to be treated with cryotherapy – it was a huge shock. Mariam became even more frightened when a smear test confirmed a malignant abnormality on her cervix.

Cervical cancer among HIV positive women in Côte d’Ivoire

Doctors advised Mariam to consider a radical hysterectomy – a $1,400 procedure, which was completely unaffordable for a woman whose earnings barely covered her living expenses from one day to the next.

Mariam said: “I was afraid and my anguish was growing each passing day. Even if I did not know a lot about this disease, I could understand it is a life-threatening disease. As a person living with HIV, I am aware that any other disease could affect my health. Honestly I feared the worst.”

Cervical cancer is the second leading cause of cancer in women in the developing world, and in Côte d’Ivoire about 6,000 women develop cervical cancer every year. Women with HIV are at even higher risk. Awareness about this disease is still very low, even among women living with HIV. Treatment is considered a very expensive option which is often not possible for patients with limited resources.

Loop electrical excision procedure

In 2009, the John Hopkins program for international education in gynaecology and obstetrics partnered with the national HIV/AIDS care and treatment programme to introduce cervical cancer prevention with VIA and treatment with cryotherapy for HIV-positive women in Côte d’Ivoire.

The programme received funding from the Center for Disease Control and the President’s Emergency Plan For Aids Relief and as a result of this partnership 20 sites in major cities throughout the country now offer cervical cancer screening and treatment services by 98 trained providers.

In March 2012, two referral sites in Abidjan and Bouaké were upgraded and began offering loop electrical excision procedure (LEEP) for treatment of large lesions. By September 2012, more than 7,300 HIV-positive women had been screened, among whom 365 with small lesions were treated with cryotherapy while 64 women with larger, pre-cancerous lesions benefited from an outpatient treatment for cervical lesions that were too large for cryotherapy.

LEEP has many advantages including a high success rate, ease of use and a low cost. This is very good news for women with a low income like Mariam Cissé. After a call in April 2013 from a midwife from Treichville Teaching Hospital informing her of this new patient treatment option which was now available to her and free, she underwent the procedure. When asked how she felt, Mariam smiled as she began to cry. “I’m relieved,” she said. “I am truly free.”

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