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Infrastructure Requirements for Human Papillomavirus Vaccination and Cervical Cancer Screening in Sub-Saharan Africa

机译：撒哈拉以南非洲地区人类乳头瘤病毒疫苗接种和宫颈癌筛查的基础设施要求

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The availability of both human papillomavirus (HPV) vaccination and alternative screening tests has greatly improved the prospects of cervical cancer prevention in sub-Saharan African (SSA) countries. The inclusion of HPV vaccine in the portfolio of new vaccines offered by the Gobal Alliance for Vaccines and Immunization (GAVI) to GAVI-eligible countries has vastly improved the chances of introducing HPV vaccination. Further investments to improve vaccine storage, distribution and delivery infrastructure and human resources of the Extended Programme of Immunization will substantially contribute to the faster introduction of HPV vaccination in SSA countries through both school- and campaign-based approaches. Alternative methods to cytology for the prevention of cervical cancer through the early detection and treatment of cervical cancer precursors have been extensively evaluated in the past 15 years, in Africa as well as in other low-resource settings. Visual inspection with 3-5% dilute acetic acid (VIA) and HPV testing are the two alternative screening methods that have been most studied, in both cross-sectional and randomised clinical trials. VIA is particularly suitable to low-resource settings; however, its efficacy in reducing cervical cancer is likely to be significantly lower than HPV testing. The introduction of VIA screening programmes will help develop the infrastructure that will, in turn, facilitate the introduction of affordable HPV testing in future. Links with the existing HIV/AIDS control programmes is another strategy to improve the infrastructure and screening services in SSA. Infrastructural requirements for an integrated approach aiming to vaccinate single-year cohorts of girls in the 9-13 years age-range and to screen women over 30 years of age using VIA or affordable rapid HPV tests are outlined in this manuscript. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region"Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012
机译：人乳头瘤病毒（HPV）疫苗接种和替代筛查测试的可用性极大地改善了撒哈拉以南非洲（SSA）国家预防宫颈癌的前景。全球疫苗和免疫联盟（GAVI）向符合GAVI资格的国家提供的新疫苗组合中包括HPV疫苗，极大地提高了引入HPV疫苗接种的机会。进一步投资以改善疫苗存储，分配和交付基础设施以及扩展免疫计划的人力资源，将大大有助于通过基于学校和基于运动的方法将SSA国家中的HPV疫苗快速引入。在过去的15年中，在非洲以及其他资源贫乏地区，已经广泛评估了通过早期发现和治疗宫颈癌前体细胞来预防宫颈癌的细胞学替代方法。在横截面和随机临床试验中，使用3-5％稀乙酸（VIA）进行目视检查和HPV检测是研究最多的两种替代筛选方法。威盛（VIA）特别适合资源匮乏的环境;但是，其减少宫颈癌的功效可能明显低于HPV检测。引入VIA筛查计划将有助于开发基础架构，进而有助于将来推出可负担的HPV测试。与现有艾滋病毒/艾滋病控制计划的联系是改善SSA中基础设施和筛查服务的另一项策略。本手册概述了旨在为9-13岁年龄段的女孩进行单年度疫苗接种并使用VIA或负担得起的快速HPV检测筛查30岁以上女性的综合方法的基础设施要求。本文是区域报告“撒哈拉以南非洲地区HPV感染和相关疾病的全面控制”区域报告的一部分，疫苗第31卷，补编5，2013年。该领域的最新进展在另一本名为“ 《 HPV感染和相关疾病的全面控制》，疫苗第30卷，增刊5，2012年

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