ECHO ELA PROJECT: INAUGURAL TELECONFERENCE – SUMMARY – MAY 29 2020

The Inaugural Teleconference for ECHO Latin America ELA Project: Monthly teleconferences about cervical cancer prevention and control programs took place on Friday, May 29, 2020.
During the inaugural teleconference, ECHO ELA Project collaborators Silvana Luciani, Pan American Health Organization (PAHO), Melissa Lopez Varon, MD Anderson Cancer Center and Sandra L. San Miguel, National Cancer Institute (NCI), welcomed 140 participants, including leaders for national cervical cancer and immunization programs from the Ministries of Health in Latin America, NGO representatives and other professionals working on related projects; Focal Points from each of the PAHO offices in Latin America, PAHO representatives from Washington, D.C., WHO in Geneva, MD Anderson Cancer Center University of Texas, and the U.S. National Cancer Institute.

The following was covered during the inaugural teleconference:

  • A brief summary of the ECHO® Institute and model established in New Mexico by Dr. Arora;
  • An introduction to the ECHO ELA Project whose goal is to assist countries to develop their national cervical cancer elimination plans and meet the WHO cervical cancer goals - 90-70-90 (90% HPV vaccination, 70% screening and 90% treatment);
  • The ECHO ELA Project Faculty members, who will provide their expertise and guide the teleconference sessions to increase the learning capacity of our participants, were presented, including Drs. Silvina Arrossi (CONICET, Argentina), Maria Tereza da Costa (PAHO/WDC), Mauricio Maza (Basic Health Int’l, El Salvador), Jane Montealegre (Baylor College of Medicine) and Mila Salcedo (MD Anderson Cancer Center University of Texas).
  • An overview of the actual cervical cancer programs and effective strategies to improve the programs’ impact during a didactic presentation on the topic ‘Elimination of Cervical Cancer in the Americas’ by Ms. Luciani.
Equipo del Proyecto ECHO ELA

Case sample to be included in ECHO discussions:

A case sample was provided, and the presenters highlighted the importance of the participants to provide public health cases given that the ECHO® model is based on the multilateral exchange of knowledge through the use of cases as the epicenter of its discussion.

Discussion:

Participants discussed the challenges that COVID-19 presents and its impact on HPV vaccination and health services. Moreover, participants are concerned about the economic crisis, which will increase existing challenges to strengthen currently existing cervical cancer programs. Participants brought up the collaboration with the Ministries of Education, low resources and vaccines in the area and how to reach populations in remote areas. We briefly discussed efforts being conducted by PAHO/WHO to address the supply of HPV vaccines in the region. We received a few questions that will be answered by our Faculty and will be distributed among our participants along with a summary of the teleconference prior to the next teleconference.

Questions

 

COVID-19 –  These questions were addressed briefly during the discussion. These topics will continue to be addressed during the next teleconferences for Proyecto ECHO ELA.

  • Vaccination:
    • What strategies are the countries that suspended the school vaccination programs due to the pandemic taking?ç
  • Screening:
    • What recommendations can be made regarding screening guidelines during the pandemic?

Access to vaccines

  • Are there any plans to engage in advocacy efforts with industry to facilitate the Access to vaccines in the region?
  • I’d like to ask Dr. Kfouri how is the vaccine production by the Ministry of Health in Brazil? And what is the perspective of becoming independent and being able to export to other countries? – Are any of our participants in touch with someone from the Butantan Institute – the agency that is producing the vaccine in Brazil? A. Goretti from Brazil may have details about this question, to follow up during our next ECHO ELA.

STRATEGIES

Self-sampling –

  • Can you provide any information about self-sampling implementation practices in Latin America?
    • In Argentina, we have implemented self-sampling in a pragmatic context
    • In Brazil, we have not fully implemented self-sampling, except for a few local projects
  • Under the current circumstances due to the pandemic, could we prioritize self-sampling as a molecular test for screening?

There are some self-sampling projects in Peru, Bolivia, El Salvador y Guatemala, some of which have been published:

This topic will be addressed extensively during a future teleconference titled ‘Self sampling to detect HPV’

School Strategy

  • In reference to the school strategy, is it recommended for the HPV vaccination program to be mandatory? – This question was addressed by Dr. Oliveira from PAHO, who mentioned that this strategy is up to each country.

Remote areas

  • In remote areas in Colombia, with difficult geographic Access, we have the strategy via vili. Could these types of strategies be considered for other remote areas during our ECHO discussions? VILI is not recommended as a primary screening strategy due to its low sensitivity. Moreover, WHO is updating screening guidelines, which will be published later this year and will be discussed during the next ECHO ELA teleconference on Friday, June 26, 2020.

Chat Comments

COVID-19

  • Dr. Sergio Becerra, Chief, Department of Cancer, Minsal Chile: the pandemic and the economic crisis will present challenges for HPV vaccination in schools.

 Self-sampling

  •  Ileana Quirós: We have noticed fewer clinic visits and HPV screening in general and we do not have self-sampling in place.

 

 Vaccination

  • Ana Goretti: In Brazil we have enough HPV vaccine supplies; however, we have not been able to meet the WHO goals. General Management: In Venezuela we do not have a general program for HPV vaccination
  • Ida Molina: In Honduras, we vaccinate girls who are 11-years old. The main strategy includes vaccination through schools. Given the present situation with COVID-19, this has greatly impacted HPV coverage. Our new strategy is to target parents asking them to demand vaccination through health clinics. 
  • Leandra- CCSS-CR: In Costa Rica, the school vaccination is also suspended due to the closings of schools. We are vaccinating by demand through health clinics; however, the coverage is very low. 
  • Perezali: In Cuba, cervical cancer is the 5th leading cause of death among women and we are conducting studies to increase vaccination. Our target population includes young girls and we’re looking for alternatives to introduce and sustain HPV vaccination practices
    Lissette Barrera: Guatemala started HPV vaccination in 2018 (girls born in 2007 and 2008), we vaccinated girls between 10 and 14-year old (born between 2006 to 2010). Among the first cohorts we have reached an accumulated coverage for the first dose between 41 and 89%. However, the coverage for the second dose is between 13 and 66%. 
  • RENEE: In Peru, we have started the reintroduction of the HPV vaccination. 
  • Perezali: In Cuba, given the present situation where financial resources are limited, it’s going to be very difficult to reach the 90% vaccination goal. We hope that new suppliers become available (increased competition) to drive down HPV vaccine costs.
    Paul Bloem, WHO: The lack of supply of HPV vaccines will be a challenge through 2023/2024. The good news is that a third producer from China just obtained a license and reached out to WHO to be able to sell internationally (probably toward the end of 2021).

 

Screening

  • Lissette Barrera: Guatemala started screening with HPV, but only in a few regions

 

Vaccination and Screening

  • Andreina Fernandes: In Venezuela we do not have screening for HPV, or a vaccination program and the political and economic situation makes it challenging to implement such programs. Speaking personally, I’m a molecular biologist and make the HPV diagnosis, but we have not had reagents to conduct the tests

 

 Study:

  • Aurelio Cruz: It would be worthwhile to conduct a quick study on the resiliency of the program in each country.

 

Please click on the link to access the recording of the meeting and feel free to share with other colleagues:

https://mediaplayer.mdanderson.org/video-full/2AF0841A-F193-4F8B-923F-52761D023895

Webinar

 

 

 

 

 

More information