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Cervical Cancer Screening and Treatment

Cervical cancer is the second most common cancer among women after breast cancer. There are 270,000 cases of cervical cancer each year with over 80% of deaths occurring in resource-limited settings. In sub-Saharan Africa, cervical cancer is a leading cause of cancer death among women. We have participated in annual free cervical cancer screening and treatment campaigns organized by MOH.
HIV is closely associated with cervical cancer. Compared to HIV-negative women, HIV-positive women are more likely to be infected with human papillomavirus (HPV) and are at higher risk for developing cervical cancer and at an earlier age.

TREE has partnered with the Ministry of Health (MOH), ATLAS coffee, and Othaya coffee farmers cooperative society to carry out free cervical cancer screening and treatment in Othaya, Nyeri. In addition, TREE has partnered with Fred Hutchinson Cancer Research Center, International Agency for Research on Cancer, Coptic Hospital, and Kenyatta National Hospital in several cervical cancer screening and treatment studies among HIV-positive women.
• We have examined how visual inspection with acetic acid (VIA), Papanicolau (Pap) smear, and HPV testing compare to the gold standard of colposcopy-directed biopsy, in order to understand which method is the best to screen for cervical cancer among HIV-positive women.
• Building upon data samples from our VIA, Pap and HPV study,  we are analyzing the presence of p16/Ki-67 biomarkers with ELISA to determine the utility of these tests in cervical cancer screening among HIV-positive women and to explore the possibility of developing these tests into an objective, point-of-care test for resource-limited settings.
• TREE has implemented a PEPFAR-funded randomized controlled trial at the Coptic Hope Center to compare cryotherapy vs. loop electrosurgical excision procedure (LEEP) on the recurrence of pre-cancerous lesions among HIV-positive women.
• We also examined the effect of cervical treatment on HIV shedding from the cervix. Cryotherapy and LEEP remove pre-cancerous lesions but they also damage the cervix in the process, which may lead to increased HIV shedding. To examine the level of HIV after cervical treatment, the TREE team collected and analyzed cervical HIV-1 RNA and DNA.
• Based on these trials, TREE is also exploring other aspects of cervical research, including HPV prevalence among HIV-positive women, HPV persistence after treatment, and the value of methylation to triage HPV results.

These studies are being conducted in collaboration with Dr. Nelly Mugo of the Kenya Medical Research Institute (KEMRI), Dr. Hugo DeVuyst of the International Agency of Research on Cancer (IARC), Dr. Barbra Richardson, of the UW Department of Global Health, and Dr. Constance Mao of the UW Department of Obstetrics and Gynecology.