FIND

Taking the fight against cervical cancer to its doorstep

By PETER NGIGE

In the ongoing battle against cervical cancer, FIND emerges as a global force dedicated to creating a new alliance for affordable and accessible diagnostic tools. Headquartered in Geneva, Switzerland with a presence in many lowand middle-income countries, FIND is a non-profit global health organization that operates as a product development partnership, collaborating with over 150 partners to facilitate the development, evaluation, and implementation of diagnostic tests for poverty-related diseases.

Through its relentless collaborations and efforts, FIND ensures the availability of diagnostic tools for tropical and neglected diseases. Their newest program, launched in 2021 and led by Dr. Angela Muriuki, is on Women’s Health, which currently focuses on high-performance HPV testing. This crucial program aims to confluence efforts to combat cervical cancer by 2030.

Dr. Muriuki's work at FIND revolves around partnering with the right individuals and organizations to improve access to diagnostic technologies that significantly impact women's and girls' health. She elaborates, "For women's health, our approach is to improve the availability of new technologies that target conditions disproportionately affecting or uniquely impacting women. We also prioritize building coalitions and partnerships with those most affected by the disease, those who bear the greatest burden."

Dr. Muriuki explains the key strategies employed by FIND to enhance access to diagnostics in women's health: "Firstly, we focus on researching and implementing new technologies that address specific needs and challenges faced by women, targeting conditions that have a significant impact on women's health." By involving affected individuals and communities in the development of their approaches, FIND ensures that their solutions are relevant and effective.

The importance of collaboration with governments is paramount in FIND's work. Dr. Muriuki emphasizes, "We work closely with government agencies to inform and contribute to screening targets, identify gaps in healthcare provision, and prioritize areas for improvement." This collaborative effort allows FIND to develop costed strategies that enhance access and availability of diagnostics at all levels of care, including self-testing.

Self-testing plays a vital role in FIND's mission, not only for HPV, but also other diseases such as diabetes. Dr. Muriuki highlights its significance, stating, "Self-testing allows individuals to collect samples at home and send them to the healthcare system for analysis, providing results quickly and conveniently." An example of this is the availability of pregnancy tests that provide immediate results, empowering women with timely information.

Ultimately, FIND's goal is to ensure everyone who needs a test can get one. In the Women’s Health program, the focus is on improving access to diagnostics for women, ensuring they receive necessary care and interventions as early as possible, even at the community level. Dr. Muriuki concludes, "Our aim is to prevent and manage diseases effectively by empowering women and enabling them to access the necessary care and interventions."

DIAGNOSTICS APPROACHES THE FIND WAY: ADVANCING ACCESSIBLE AND EFFICIENT TESTING

The standard practice for diagnosing cervical cancer involves the visualization of the cervix by a medical professional, which many find intrusive and uncomfortable. Dr. Angela Muriuki, an advocate for improved diagnostics, recognizes the need for a more accessible and less invasive approach. She acknowledges that cultural barriers and the shortage of female healthcare professionals contribute to the reluctance of women to prioritize cervical screening and HPV vaccination.

FIND is at the forefront of promoting selfcollection of samples as a solution. Dr. Muriuki explains, "Samples are collected by individuals themselves and sent to laboratories for highperformance DNA testing to determine HPV positivity or negativity." This approach empowers women by offering a more comfortable and convenient alternative.

Dr. Muriuki highlights the potential of this approach, stating, "It has been scientifically proven that the virus can survive in dry media, making self-collection a viable option for many countries striving to achieve the World Health Organization 90-70-90 targets." By embracing innovative testing methods and technologies, FIND and partners aim to revolutionize the field of diagnostics.

The role of digital advancements in diagnostics is significant. Dr. Muriuki notes, "Digital technology enables us to decentralize testing availability, conducting diagnostic tests in primary healthcare facilities, clinics, or even remote areas." This approach allows for data generation and diagnosis closer to individuals' communities, improving accessibility.

In terms of result delivery, digital platforms play a crucial role. Dr. Muriuki explains, "A seamless process is essential. Digital technology ensures individuals receive their test results in a timely manner." Similar to the experience with COVID-19 testing, where results were sent directly to individuals, the use of digital platforms streamlines the result return pathway.

The integration of digital technology offers additional benefits. Dr. Muriuki elaborates, "Digital platforms can track samples, ensuring correct linkage between multiple samples and respective individuals' results, minimizing errors during laboratory processing." By combining testing technology and digital solutions, diagnostics become more accurate, efficient, and convenient.

Closing the loop in the result return pathway is paramount. Dr. Muriuki emphasizes, "Digital technology aids in managing the flow of information and delivering results to individuals conveniently." The comprehensive approach ensures that individuals can access their results without the need for unnecessary visits to healthcare facilities.

Paving The Way To Eliminate Cervical Cancer By 2030

"How do we get on track to meet the 2030 target and why we want to meet the 2030 target is because it then means we could be the generation that sees the elimination of cervical cancer in our lifetime," Dr. Angela assured, emphasizing the urgency of addressing this global health issue.

Cervical cancer, a unique form of cancer, holds the potential for prevention, treatment, and even elimination. Dr. Muriuki sheds light on the significance of setting targets and goals in the fight against this disease. She explains, "Setting targets for 2030 provides countries with a roadmap to assess their progress towards eliminating cervical cancer."

Unlike many other cancers, cervical cancer is preventable, treatable, and ultimately, eliminate-able. Dr. Muriuki emphasizes the importance of recognizing these qualities unique to cervical cancer. She adds, "Because cervical cancer is one of those cancers where we use words you don't hear with other cancers, preventable, treatable, and eliminate-able. By establishing specific goals, nations can work towards controlling the disease to the point where it is no longer a significant public health concern.

One of the key targets set for 2030 is to ensure that 90% of girls receive full vaccination against the human papillomavirus (HPV). Dr. Muriuki underscores the importance of HPV vaccination as a crucial preventive measure, stating, "By achieving high vaccination coverage among girls, the risk of HPV infection and subsequent development of cervical cancer can be significantly reduced."

However, HPV vaccination is not the sole focus. Dr. Muriuki highlights the multifaceted approach, saying, "Other targets, which may vary depending on the country, include increasing access to cervical cancer screening and ensuring timely treatment for those diagnosed with the disease." These targets collectively aim to improve prevention, early detection, and treatment outcomes, ultimately leading to the elimination of cervical cancer as a public health problem.

"To achieve the targets set for cervical cancer elimination by 2030, several key actions need to be taken," Dr. Muriuki emphasizes. The urgency to address this global health challenge is paramount, and she outlines the essential steps required to make significant progress.

"These actions include vaccinating 90% of girls against HPV, screening 70% of women using high-performance

HPV tests, and ensuring that 90% of women who test positive for HPV are linked to appropriate treatment," Dr. Muriuki explains. These ambitious targets are an integral part of the World Health Organization's '90-70-90 strategy,' a comprehensive approach designed to tackle cervical cancer from multiple angles.

Vaccination against the human papillomavirus (HPV) is a critical measure in preventing cervical cancer. Dr. Muriuki highlights the importance of achieving high vaccination coverage among girls, stating, "By vaccinating 90% of girls against HPV, we significantly reduce the risk of HPV infection, which is the primary cause of cervical cancer."

Screening plays a vital role in early detection and intervention. Dr. Muriuki stresses the need to implement high-performance HPV tests, stating, "Screening 70% of women using these advanced diagnostic tests allows for more accurate detection of HPV infection and early identification of precancerous lesions, enabling timely intervention and treatment."

However, screening alone is not sufficient. Dr. Muriuki emphasizes the importance of ensuring that women who test positive for HPV are promptly linked to appropriate treatment. "It is crucial to establish a seamless pathway that guarantees timely access to treatment for those diagnosed with cervical cancer or precancerous lesions," she states. This comprehensive approach aims to improve treatment outcomes and ultimately reduce the burden of the disease.

The '90-70-90 strategy' developed by the World Health Organization provides a roadmap for countries to assess their progress towards eliminating cervical cancer. Dr. Muriuki explains, "These targets are part of a comprehensive approach that addresses prevention, early detection, and treatment. By focusing on these key areas, we can work towards eliminating cervical cancer as a public health concern."

Dr. Muriuki highlights the challenges faced by many countries, particularly developing nations, in implementing these targets. "Seven years out and most countries, especially developing nations, have yet to establish even vaccination programs for HPV or introduce high-performance testing as a standard of care." This highlights the urgent need for increased efforts and resources to bridge these gaps and accelerate progress.

An Unlikely Frontrunner In The Race To End Cervical Cancer

The case of Rwanda stands as a shining example of effective cervical cancer prevention, with the country achieving remarkable success in HPV vaccination, screening, and treatment. Dr. Angela Muriuki, an expert at FIND, commends Rwanda's efforts and emphasizes the importance of comprehensive and widespread interventions.

"This vaccination should be done comprehensively and at scale, without picking and choosing specific groups," Dr. Muriuki asserts. She highlights Rwanda's achievements in introducing and expanding HPV vaccination, emphasizing its role in reducing the risk of cervical cancer development among girls as they reach adulthood.

In 2008, Rwanda faced significant challenges, with 34.5 cases of cervical cancer and 25.4 deaths per 100,000 inhabitants. However, by 2020, the rate had reduced to 28.2 cases per 100,000, a significant decline attributed to the government's commitment to eliminate the disease by 2030. Rwanda implemented a nationwide HPV vaccination program for girls, with nearly 1.2 million women receiving two doses by 2022.

Nevertheless, many low- and middle-income countries, particularly in Africa and Asia, struggle to reach these targets. Dr. Muriuki emphasizes the importance of collaboration with governments to bridge the gaps and improve access to HPV-related services.

"Collaboration with governments involves assessing the availability and accessibility of HPV vaccination and testing. It is crucial to ensure that HPV vaccines are accessible to all girls and that the vaccines are effectively utilized," Dr. Muriuki explains.

“Similarly, HPV testing should be available and affordable to women from all backgrounds, including those in rural areas or with lower socioeconomic status. Ideally, testing should be free or affordable,” she adds.

After receiving positive HPV test results, a clear protocol for further evaluation and treatment is necessary. Dr. Muriuki emphasizes the significance of confirming the presence of precancerous lesions and providing appropriate treatment. Early detection plays a pivotal role in the effective treatment or cure of cervical cancer.

Efforts should be made to make the screening process timely, affordable, and womencentric. Dr. Muriuki suggests the use of highperformance testing methods preferred by women. “Self-collection is one such approach, allowing women to collect their own samples for HPV testing at home or in healthcare facilities.

In Numbers

1.2M NUMBER OF RWANDESE WOMEN VACCINATED AGAINST HPV BY 2022

This approach eliminates the need for a pelvic examination by a doctor, enhancing comfort and convenience.”

By addressing these challenges and promoting women-centric testing approaches, more women can access HPV testing, leading to early detection and improved outcomes in cervical cancer prevention and treatment.

Investing in high-performance testing methods and ensuring their accessibility to all women, regardless of socioeconomic status, is crucial to improving screening rates. Addressing healthcare infrastructure gaps and establishing screening programs in remote areas are essential steps. Training healthcare workers and facilitating the timely delivery of results to women are key factors in enhancing screening services.

"By addressing the challenges and barriers related to HPV vaccination and screening, countries can make significant progress in reducing cervical cancer rates," Dr. Muriuki affirms. Achieving these goals requires public awareness, political commitment, healthcare system strengthening, and equitable access to services.

The Winkers In The Dark

In the realm of cervical cancer prevention, small organizations often feel like they're "winking in the dark," as eloquently described by Dr. Angela Muriuki. She shares the sentiment expressed by

Benda Kithaka, the executive director of Kilele Health, stating, "When you're a small organization somewhere, it feels like you're winking in the dark. You're winking and no one can see you. But once you become a big coalition, suddenly the lights come on. And so, she says, they've been winking in the dark. But this power of partnership and bringing together little winkers in the dark, the light comes on and suddenly everyone can see you."

The transformative partnership between FIND and Kilele Health has enabled Kilele Health to effectively connect with and support community networks in the fight against cervical cancer. The role of the convening organization rotates among coalition members to ensure shared leadership and governance, as explained by Dr. Muriuki. Together, they raise their voices to challenge governments, advocating for support and assistance. Dr. Muriuki emphasizes, "We have brought those voices together to challenge, to speak to governments and tell them, this is how you would have helped me. It's too late for me, but now help somebody else."

This partnership provides the necessary resources and shared vision to advance the goal of eliminating cervical cancer in Africa. By listening to the experts—the women at risk and those affected by the disease—FIND and Kilele Health can work together to implement the necessary actions. The engagement and interest across the 16 countries involved in the coalition are significant. Kilele Health actively identifies and onboards partners on the ground, recognizing the power that comes from uniting smaller voices into a larger collective.

Dr. Muriuki outlines the shared vision of the coalition, stating, "The shared vision is to eliminate cervical cancer through prevention, treatment, and cure. The goal is to create a global movement where all stakeholders, including funders, manufacturers, governments, and coalitions like the Kilele-led coalition, work together towards this common objective."

FIND's specific contribution focuses on the diagnostics space, particularly ensuring access to high-performance screening technologies like HPV-DNA testing. The ambition is to make these technologies affordable, accessible, and efficient, with timely return of results and clear pathways to treatment for those who test positive. Currently, FIND's dedicated resources are aimed at bridging the gap in availability and accessibility of these screening technologies.

BUILDING MOMENTUM TOWARDS 90-70-90

Cervical cancer screening plays a pivotal role in early detection, even in the absence of high-performance testing options, as emphasized by Dr. Angela Muriuki. She highlights the significance of screening, stating, "To summarize, it is important to emphasize the significance of screening for cervical cancer even without high-performance testing options." Despite any discomfort or invasiveness experienced, early detection through available screening methods remains crucial in the fight against cervical cancer.

Nevertheless, the ultimate objective is to make highperformance HPV testing widely accessible and affordable, inspired by countries like Australia, which aims to eliminate cervical cancer by 2035. Organizations such as FIND are actively working towards achieving this goal by collaborating with manufacturers on pricing and exploring options for local manufacturing.

Moreover, FIND is dedicated to optimizing the testing process by identifying components that can be omitted without compromising accuracy. These efforts aim to make HPV testing more accessible and cost-effective, particularly in low-income countries. Dr. Muriuki points out the potential of using a dry swab as an alternative method for sample collection, emphasizing how it can significantly reduce costs and transform the dynamics of sample collection. Women would be able to collect the swab at home and drop it off at a collection center, revolutionizing accessibility.

Dr. Muriuki confirms the ongoing efforts to make HPV testing more accessible and convenient. She states, "Efforts are underway to make HPV testing more accessible and convenient." The goal is to ensure that self-collected samples yield results of similar quality as those collected by healthcare workers, thus increasing accessibility to vital screening services.

To achieve this, extensive research and clinical trials are being conducted to validate the effectiveness of self-collection. By empowering women to take charge of their own testing,

FIND aims to break down barriers and expand access to cervical cancer screening.

Dr. Muriuki emphasizes the significance of this advancement, stating, "Extensive research and clinical trials are being conducted to validate the effectiveness of self collection, empowering more women to take charge of their own testing."

This shift towards self-collection represents a significant step forward in cervical cancer prevention, allowing women to play an active role in their own healthcare journey.

Dr. Angela Muriuki, a leading voice in cervical cancer prevention, highlights the power of individual actions in contributing to cervical cancer prevention and awareness. She emphasizes, "As an individual, you can take several actions to contribute to cervical cancer prevention and awareness. Educate yourself about the disease and understand the importance of HPV vaccination."

Education is the foundation of prevention. By arming ourselves with knowledge about cervical cancer, its risk factors, and prevention methods, we become empowered advocates in the fight against this devastating disease. Understanding the importance of HPV vaccination is a key aspect of our education. Dr. Muriuki urges, "Encouraging girls aged 10 to 12 years to get vaccinated, available in public health facilities, is vital."

But prevention doesn't stop with vaccination alone. Dr. Muriuki advises, "Women above 25 years should seek cervical cancer screening at the nearest facility, even if HPV DNA testing is not widely available."

“By taking advantage of the screening options currently offered and staying updated on advancements in screening technologies, we can be champions for cervical cancer prevention,” she says.

Dr. Muriuki concludes with a strong call to action, urging, "Catch it early, don't wait for symptoms. Go for screening.”