Feasibility of implementing and integrating cervical cancer screening and treatment of precancerous lesions into the public health system in three states in Nigeria

Background: Cervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here the implementation and integration of practical routine cervical cancer screen and treat services into the public health system in Nigeria. Methods We conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA). Results 83,593 women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (<1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 1,956 women were identified with precancerous lesions, and 1,874 (96%) received treatment. Of the 194 suspected cancer cases identified, 85 (44%) were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported. Conclusions Routine cervical cancer screening and treatment was found to be feasible in a public-health setting. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Furthermore, additional investments into strengthening laboratories across the country are necessary for seamless HPV testing.