ECHO Latin America ELA Project: Second session – 26 June2020

Dr. Ileana Quiroz (Costa Rica) – Has progress been made in the active training of women, what are the strategies that have been put in place for women to be screened, and how are they followed up with when they have positive tests?

Dr. Suyapa Bejarano (Case Presentation, Honduras) – The community base includes cancer organizations, women’s groups, and churches who promote the screening services in the community. The institution provides all the materials and the equipment. The results are recorded and turned in, and we have an 89% rate of follow-up and treatment of patients because treatment is free. All patients who have suspicious lesions are referred to colonoscopies. If they need thermal therapy, they receive treatment, and if the patients need major surgery or have a very advanced cancer, then they can be referred to one of the cancer hospitals.

Dr. Jackie Figueroa (Health Secretary, Honduras) – We have had the opportunity to implement HPV tests and have made progress in identifying how to introduce this test, considering all aspects involved in terms of education, human resources, information systems, etc. We have collaborated with “Ciudad Mujer” supporting colposcopies and have collaborated with the local university to continue training medical professionals. The Cancer Unit needs to be restructured. We are working on the governance to structure a comprehensive plan to address this issue.

Dr. Mila Salcedo (ECHO ELA Faculty – MD Anderson Cancer Center) - Emphasized the importance of developing National Cervical Cancer Control Plans and the importance of being able to identify the gaps in primary care and identify at what point the patients are lost. Dr. Salcedo also highlighted the importance of providing timely treatment during screening.

Dr. Maria Tereza da Costa (ECHO ELA Faculty – PAHO/WDC) – Congratulated Dr. Suyapa for the case presentation and for highlighting the gaps in primary care, which can be corrected. She suggested that the information generated through this program should be shared with the national immunization program. The only vaccine available for the region, which is very cost effective, is the quadrivalent vaccine and guarantees to cover around 70% of cancers. Our biggest challenge is vaccination coverage, and we must focus on this issue.

Dr. Ida Molina (Health Secretary, Honduras) – The country’s challenge is to accelerate the development of the Cervical Cancer Control Plan. There have been some advances due to coordination, although the pandemic has presented a major challenge. However, we must continue to request for the country to prioritize this issue at the political level, and we need to continue seeking all possible opportunities to move this forward. Vaccination continues to be a challenge and is even worse with the pandemic. Findings from all studies should be disseminated to learn from one another and protect girls’ health.

Dr. Silvina Arrossi (ECHO ELA Faculty – Argentina) – Have the incorporation of See and Treat strategies and visual inspection been considered as alternative methods to solve some of the access and coverage problems and do you have an information system? In our experience, the implementation of an information system allows monitoring of the entire continuum of care (screening, diagnosis, and treatment) and is one of the fundamental axes of the program. Once this is established, the other steps can be structured more easily.

Dr. Suyapa Bejarano (Case Presentation, Honduras) – The Department of Cervical Pathology has focused substantially on the quality that is provided. A Telemedicine system has been established for visual inspection. See and Treat has not been implemented because there are no resources for on-site treatment, and we have not achieved a quality care curve that allows us to guarantee that we are solving the patients’ problem. The visual inspection has been a success, having trained 79 medical students and evaluated approximately 5,000 women. Through telemedicine, we can ascertain the quality of the diagnosis.

Dr. Jaqueline Figueroa (Health Secretary, Honduras) – Since 2015, we have implemented a training for visual inspection, cryotherapy, and thermal ablation. Studies were published in which health personnel performed visual inspection and took biopsies and were very effective. It is important to identify doctors from community health centers with the ability to do visual inspections and with adequate equipment to do the treatment. Among the 15% of women positive for HPV, it was found that 50% had some type of lesion. Training must be well-structured with proper monitoring and evaluation. An entire information system has been developed and is being implemented in some municipalities. The lack of internet and computer access presents a major challenge.

Dr. Eliana Wendland (Brazil) – Mentioned the difference between vaccination and the prevalence of HPVs that cause cancer, such as strain 16 and 18. The prevalence of HPV 18 in Brazil is low. Just because it’s low, it does not mean that it is not important. When addressing the issue of screening, there must be an adaptation on the screening process in Latin American countries.