Côte d'Ivoire: Self-Testing extends Cervical Cancer Screening Services
Cervical cancer is the leading cancer affecting women in Côte d'Ivoire, with 2360 new cases recorded in 2022, and a mortality rate of 62%. 'The main drivers of this high mortality rate are late diagnosis, limited access to treatment, the complexity of pre-therapeutic care pathways, and a general lack of awareness about the disease,' explains Dr Simon Boni, lead researcher and head of partnership development and multisectorial engagement at the National Cancer Control Programme (PNLca).
Yet, cervical cancer is preventable through vaccination and can be effectively treated if detected early. In 2019, the government of Côte d'Ivoire launched the Scale Up Cervical Cancer Elimination with Secondary Prevention Strategy (SUCCESS). Supported by World Health Organization (WHO) in the African Region and the global health initiative UNITAID, this project aims to eliminate cervical cancer as a public health concern in two African countries: Côte d'Ivoire and Burkina Faso.
Two years ago, Côte d'Ivoire integrated self-testing into its national strategy, significantly improving access to screening – especially for women living with HIV, who are six times more likely to develop cervical cancer. Chantale, a woman in her 40s who tested positive for HIV in 2016, chose self-testing after receiving guidance from health staff.
'I did the self-test for cervical cancer and it came back positive. I was surprised – I had no symptoms. But the doctor told me the disease was not far advanced and that treatment would help me recover,' she recalls. 'It was a tough journey, but my family gave me a lot of support during the difficult moments. Thank God, I was declared cured after five years of treatment.'
Between 2021 and 2023, more than 40 000 women were screened through the SUCCESS project across four health regions : Abidjan 1 and 2, Gbèkè and Haut-Sassandra. Self-testing, where women collect cervical cell samples themselves, has increased confidence and comfort, while reducing cultural barriers to screening.
'Health providers often prefer to offer self-testing rather than performing the sample collection themselves, partly due to heavy workloads. The time saved can be used to complete essential programme monitoring,' explains Dr Boni.
In 2022, 51% of women attending health centres offering self-testing opted for this method. By 2023, this figure had reached 90%.
At Saint Camille Hospital in Bouaké, which specializes in care for people living with HIV, the Ministry of Health, with support from WHO, has implemented a secondary prevention strategy for cervical cancer focused on screening for human papilloma virus (HPV).
The Ministry, supported by WHO, has also trained 20 health professionals in community outreach, HPV testing, visual inspection after application of acetic acid (VIA), and treatment using thermal ablation. Within three months, the trained team at Saint Camille Hospital supported 46 women living with HIV to use the HPV self-sampling test.
« Thanks to self-testing, we were able to detect the disease at an early stage in some of our patients, allowing them to receive timely and appropriate treatment,' said Dr Françoise Milolo, general practitioner and head of the screening team at Saint Camille Hospital.
From 34 health centres at the start, the number of health facilities offering this service has grown to over 200, boosting women's confidence and encouraging greater uptake of screening. « Early detection remains one of the most effective ways to fight cancer among women, » explains Agnès Diasso, a midwife and cervical cancer screening provider. «Many women have avoided premature death thanks to the identification and treatment of precancerous lesions. We must take every opportunity to integrate screening services into our health centres, whether through sexual and reproductive health programmes or HIV care centres.'
WHO continues to support Côte d'Ivoire in developing strategies to accelerate the elimination of cervical cancer, with a target of reaching 70% of eligible women by 2030. The country's model, especially for reaching women living with HIV, represents a promising approach to scaling up screening.
'When HPV tests are integrated into the national programme, self-sampling becomes a powerful complementary option,' said Dr Fatim Tall, Programme Coordinator and Technical Adviser for Maternal Health at WHO in Côte d'Ivoire. 'Many women feel more comfortable collecting their own samples, rather than undergoing a clinical exam.'
Distributed by APO Group on behalf of World Health Organization - Ivory Coast.
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