London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine has received 3 million Euros from the European Union Seventh Framework Programme under grant agreement number HEALTH-2010-F2-265396 to run the HARP Consortium ('HPV in Africa Research Partnership'), which is designed to provide a better evidence base to guide future cervical cancer screening programmes for women living with HIV in Africa.

The announcement coincides with the 5th Cervical Cancer Prevention Week (23-29 January 2011) organised under the auspices of the UICC (Union for International Cancer Control) and the ECCA (European Cervical Cancer Association) and ahead of the World Cancer Day on 4th February 2011.

Every year, over a quarter of a million women die of cervical cancer, a disease that has become almost entirely preventable through screening and vaccination against the infectious agents that cause 70% of these cancers, the human papillomavirus (HPV) types 16 and 18. The bulk of cancer cases and mortality is found in developing countries, where women seldom have access to any form of cancer prevention and detection. The situation is even worse for women living with HIV who are at a particularly high risk of being infected and to experience fast disease progression.

The European Union has already introduced policies to deal with the issue of cancer, such as those that aim to improve general health by promoting healthier lifestyles and also increasing effective screening programmes. However, the EU is concerned about the inequalities between member states, and between more advanced and less developed countries in levels of cancer control and care, including screening.

Between 2010 and 2014, the HARP Consortium will work in Burkina Faso and South Africa, two countries representing two very contrasting health infrastructures and HIV epidemics, yet facing similar challenges in terms of cervical cancer prevention and care. Two main research hypotheses will be addressed by HARP:

1. The use of simplified point of care diagnostic tests to detect high-risk HPV genotypes, which have never before been evaluated in Africa, alone or combination with other tests, and which have the potential to improve the coverage of cervical cancer screening in high-risk populations, and to form the basis a cost-effective cervical cancer prevention intervention; and
2. immune restoration and control of HIV replication through highly active antiretroviral therapy (HAART) or HAART initiation which may improve clearance of HPV infection among high-risk HPV infected women, and which could slow the development or progression of cervical precursor lesions.

Working in partnership with academic institutions in the two African countries (the University of Ouagadougou in Burkina Faso and the University of Witwatersrand in South Africa) and University of Montpellier in France, the HARP Consortium will evaluate the cost-effectiveness of various screening strategies leading to earlier detection and management of cervical cancer in these high-risk populations, and model its long-term impact on cancer reduction and lives saved. Moreover, HARP will enhance the local capacity of front line health workers, policy makers and communities in tackling cancer prevention. The HARP Consortium will disseminate best practice in cervical cancer screening in Africa and promote evidence for effective decision-making.

Philippe Mayaud, Reader in Infectious Diseases & Reproductive Health at the London School of Hygiene & Tropical Medicine, is leading the project. He comments: 'Interest in cervical cancer prevention in developing countries is mounting, more so since the advent of the two highly effective HPV vaccines. However, before these vaccines can impact on cancer rates (which will be many years ahead), it will still be required to organise cervical cancer screening programmes that can reach many women at risk and be affordable and sustainable'.

'The development of simplified HPV screening tests holds great promise, particularly for high-risk women such as those who live with HIV. The irony is that we can nowadays save lives with potent antiretroviral therapy for HIV, and yet are unable to detect a perfectly preventable cancer that would kill these patients. I am looking forward to generating evidence with my colleagues to guide program decisions for action, so that fewer women living with HIV in Africa and elsewhere will die in future of this totally preventable disease'.