Supporting the Cervical Cancer Elimination Program in Marshall Islands and Fiji

Chugai Pharmaceutical is supporting an umbrella program conducted in collaboration between the United Nations Population Fund (UNFPA) Pacific Sub-Regional Office and the Departments of Health in Fiji and Marshall Islands to eliminate cervical cancer as a major threat to women's health in Fiji and the Republic of Marshall Islands.

• Background
  Cervical cancer represents a critical health challenge in the Pacific Island Countries and Territories (PICT), being the second leading cause of cancer-related deaths among women. Human Papilloma Virus (HPV) is identified as the causative agent in 99% of cervical cancer cases, underscoring the importance of vaccination, treatment of HPV infections, and early detection screening methods in efforts to eliminate the disease.

  The absence of well-structured cervical screening programs in many PICTs contributes to late-stage diagnoses, where treatment options are severely limited Current estimates reveal that the Melanesia(which includes Fiji) and Micronesia region (which includes the Republic of Marshall Islands: RMI,) have the highest incidences of cervical cancer, at 28.3 and 18.7 cases per 100,000 females per year respectively, compared with the global average of 10.8*¹. The burden of cervical cancer in these territories is intensified by several factors, including inadequate access to public health services, low HPV vaccination rates, ineffective screening initiatives, and insufficient clinical management.
  
  In Fiji and RMI, a comprehensive program is underway to eliminate cervical cancer, a significant threat to women's health. The United Nations Population Fund (UNFPA), Pacific is partnering with the Ministries of Health in Fiji and RMI to implement a "Test and Treat" program focused on early detection of cervical cancer and timely treatment of precancerous lesions and early-stage cancers. This collaborative and comprehensive effort offers hope for a future where cervical cancer is no longer a threat to women in Fiji and the RMI.

  
  
  

• Period of reporting
  The time frame of this interim report is January – December 2024.
  
  
  

• Results
  1. Activities in the Republic of Marshall Islands

To pave the way for a successful cervical screening program in RMI, UNFPA Pacific supported the country in developing the nation's first-ever cervical cancer elimination policy and strategy. This groundbreaking policy, was launched by Her Excellency President Dr. Hilda C. Heine during the 15th Triennial Conference of Pacific Women in July 2024, signifying a major step forward in the fight against cervical cancer and demonstrates RMI's commitment to protect the health and well-being of its female citizens.

To facilitate the implementation and roll-out of the screening program, a comprehensive situational analysis was conducted in June 2024. This analysis assessed the country’s healthcare worker capacity, equipment availability (including gene expert capacity), potential screening hub locations, and the health-seeking behaviors of the population. Based on the findings, four thermal ablation machines and 800 HPV testing kits have already been procured for the country. To finalize the rollout strategy, a crucial meeting with the RMI Ministry of Health is scheduled for the last week of January 2025. This meeting is expected to finalize the implementation plan for an efficient HPV test and treat program in the country.

      
         2.Activities in Fiji Islands

In June 2024, with the support of UNFPA, Fiji conducted a pilot introduction of the gold standard HPV DNA screen and treatment process in three sites Levuka, Galoa, and Lyndhurst (Company located in Nasinu, Fiji). The HPV screen-and-treat model is consistent with Fiji’s commitment to transition to primary HPV-based cervical screening which is based on robust scientific evidence of the clinical performance, safety, acceptability and cost-effectiveness of this approach. This HPV screen-and-treat model that was successfully introduced comprises of the following field-tested innovations:

1. specimen provider/self-collection by women attending screening clinics.
   
   
2. point-of-care HPV testing at the clinic on the GeneXpert molecular platform.
   
   
3. same-day curative treatment of cervical pre-cancer using a new, battery-operated, portable, thermal ablation device 
   
   

A total of 837 women between the ages of 20 to 69 years were screened, at an average of 76 clients screened per day within a 2-week period. There were 808 conclusive results out of which 82% (663) tested negative; 16% (138) tested positive and needed to be examined and treated by a health worker. Of those who tested positive 78% (108) were amenable to and had point of care thermal ablation treatment, while the remaining 22% (30) were referred for specialist care. With robust quantities of the HPV test and treat supplies now in hand, Fiji Ministry of Health aims to advance the progress made during the pilot program held in July 2024 by rolling out the test and treat program in strategic locations across the country. Just like RMI, with UNFPA’s support Fiji is also poised to revise its national cervical cancer policy in February 2025 to accelerate the elimination of cervical cancer in the country. Through this collaborative endeavor, the Fiji Ministry of Health and Medical Services (MHMS) aims to develop a more effective framework that will ultimately lower the rates of cervical cancer and improve health outcomes for women across Fiji.

• Situation of the site

1. The Global Cancer Observatory

https://gco.iarc.fr/en

2. Global strategy to accelerate the elimination of cervical cancer as a public health problem.

https://www.who.int/publications/i/item/9789240014107