Cervical cancer research

 SA research helps diagnose and treat SA’s most prevalent women’s cancer  

Johannesburg, Thursday 8 October 2015: Cervical cancer is the most prevalent cancer for women in South Africa - the statistics indicate that one in 26 women will get it.  But it is also the most preventable cancer.  
To  find ways to better prevent and treat this condition, the research division of Right to Care, headed by Professor Cindy Firnhaber, submitted two  groundbreaking presentations at the 30th International Papillomavirus Conference & Clinical Workshop (HPV 2015), held recently in Lisbon, Portugal.  
Improving treatment
Once Pap smear test results confirm cervical abnormalities, the current accepted treatment is to cut these out with an outpatient surgical procedure. Prof Cindy Firnhaber, lead investigator at Right to Care, studied a less invasive and quicker treatment which can be carried out by a nurse and has potentially reduced side effect risks: cryotherapy, a treatment which involves freezing the abnormalities.
In South Africa, the surgical removal must be performed by a doctor who uses the LEEP (Loop Electric Excision Procedure).  It requires local anaesthesia and highly trained personnel, and the patient is at increased risk for cervical bleeding and infection following the procedure.
At present,  access for treatment of cervical abnormalities is very limited in the government healthcare sector.  Often treatment requires the woman to travel to a referral hospital which maybe many kilometres away and she may need to wait up to 6 - 9 months for treatment.   This combination often results in women being lost in the system and not getting the care they need to prevent progression of their cervical abnormalities to cancer. 
Firnhaber’s investigation involved 166 HIV positive women who attend Right to Care’s Themba Lethu Clinic at Helen Joseph Hospital. The research, which was funded by PEPFAR through USAID, had extremely promising results and indicated that at six months LEEP does a better job than cryotherapy but at 12 months, the effectiveness of LEEP and cryotherapy are not statistically different.
“Despite cryotherapy taking somewhat longer to be effective, this provides an alternative treatment for cervical abnormalities which can be done in a local clinic. This avoids the need for the woman to travel and also expands much-needed access to treatment,” Firnhaber explains.
Improving detection
HPV testing has traditionally involved taking a vaginal swab and sending it to a laboratory for testing. The process is expensive and results take time. Firnhaber in collaboration with Dr Zizipho Mbulawa in Prof Williamson's laboratory at the University of Cape Town tested a new diagnosis tool which allows for the vaginal swab to be tested at the clinic and the results are available within an hour.  The device is so simple to operate that the test can be performed by someone who does not have laboratory technician training.
The diagnosis tool uses Gene Xpert technology, which has been used to for the past few years to revolutionise the diagnosis of TB. It allows rapid diagnosis of TB in around two hours instead of the traditional microbiology method which took approximately 48 hours. This machine was modified by its manufacturers to do HPV testing. HPV is the human papillomavirus which is one of the most important infectious causes of several cancers. High-risk HPV types are associated with almost 100% of cervical cancers so diagnosing this efficiently is critical in the fight against this cancer.
Prof Firnhaber wanted to research whether the GeneXpert was a viable test for HIV positive women. The research involved doing both tests (sending swabs to a lab and testing on GeneXpert) for 1163 patients and comparing the results. The quicker, cheaper GeneXpert test performed as well as the laboratory tests. “This is particularly good news for those who do not live near the major laboratories,” Firnhaber comments.
About cervical cancer
Women that are HIV positive are three to five times more at risk for cervical cancer. The disease can be detected early by having a Pap smear and then it can be treated.  There are often no symptoms for cervical cancer and that is why it is necessary to have regular Pap smears.
Women should have a Pap smear from age 30 if HIV negative and every year if HIV positive. Risk factors for cervical cancers include having sex at an early age, sexually transmitted diseases especially HIV, having multiple partners, smoking and using oral contraception from a young age. ENDS
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New national guidelines
National Consolidated Guidelines
for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults
About Right to Care

Right to Care is a non-profit organisation (Section 21) that supports and delivers prevention, care, and treatment services for HIV and associated diseases.

Through technical assistance, Right to Care supports the Department of Health at national level. Support at provincial level is provided primarily in five provinces: Gauteng, Mpumalanga, Northern Cape, Western Cape, and Free State. In addition, through direct service delivery, Right to Care treats patients for HIV, TB, cervical cancer, and sexually transmitted infections.

Support for clinical programmes is delivered through development of clinical best practices, research, training, mentoring, participation in technical committees, provision of facilities and equipment, and secondment of staff, among others services.

Funding and revenue

The chief funding and revenue streams are:

  • The President’s Emergency Plan for AIDS Relief (PEPFAR), managed by USAID
  • Global Fund
  • Private-sector donors
  • Revenue from the private sector for provision of employee wellness services (through Right to Care Health Services)

HIV care and treatment

Right to Care’s Adult HIV and Paediatric HIV programmes support the clinical care and treatment of individuals infected with HIV and associated diseases. Care and treatment is accessible through an integrated model that includes prevention, transition into care, treatment adherence, and nurse initiated and managed ARV treatment (NIMART). Loss-to-follow-up is minimised using innovative approaches, such as automated text messages and patient transfers with electronic records.

On-site and didactic training are provided to clinicians in the public and private sectors. In each province, centres of excellence are hubs for mentoring and training and for referrals of complicated cases.

In its first ten years of operation, Right to Care initiated over 230 000 patients on ARV therapy.


Right to Care’s TB programme provides integrated TB/HIV services for both drug-sensitive and drug-resistant TB. Components of Right to Care’s TB strategy include use of the ‘‘3 Is’’: Intensified case finding; INH Preventative Therapy (IPT); and Infection control in health facilities.

TB symptom screening is done at all healthcare visits. Sputum induction facilities reduce by 10% the number of patients who cannot produce sputum, leading to improved testing rates.

Right to Care has spearheaded the use of the Cepheid GeneXpert MDR TB Rif for rapid diagnosis of TB and of drug resistance.
The diagnosis and management of Multidrug and Extensively Drug-Resistant TB is supported, in particular at Sizwe Tropical Diseases Hospital, Johannesburg. On an on-going basis, Right to Care collaborates in TB research studies.

Cervical cancer

At present, our most important weapon against cervical cancer is an effective screening and treatment programme to detect and remove early cervical dysplastic lesions. Right to Care trains medical officers to perform colposcopic biopsies and large loop electrical excisions (LLETZ). These cost-effective procedures have resulted in greatly improved access to treatment.

Mobile clinics take screening and treatment services, and other women’s health services, to remote areas.


Right to Care’s prevention programmes include treatment as prevention, medical male circumcision (MMC), HIV counselling and testing (HCT), and prevention of mother-to-child transmission (PMTCT).

Right to Care advocates treatment as prevention. Among discordant couples, ARV therapy has been shown to reduce by 90% the rate of transmission from one partner to the other.

Annually Right to Care conducts over 300 000 HIV tests.

Through technical assistance and direct service delivery, Right to Care is supporting the DoH in the delivery of MMC services. MMC is offered as a comprehensive package of services that includes HCT, the provision of condoms, and education for behaviour change. MMC clinics are optimised for high-volumes.

Right to Care’s integrated PMTCT and Maternal & Child Health unit provides technical assistance for prevention for mothers, immunisations, reproductive health services, basic antenatal care, and PMTCT at supported sites.

Pharmacy supply chain management

Right to Care’s pharmacy programme supports the DoH at national, provincial, district, and facility levels. Programme staff members play an important role in the development of pharmaceutical policy. Right to Care supports the Medicines Control Council for the registration of medicines and for the regulation of clinical trials. Right to Care supports the site-level implementation of computerised pharmacy dispensing and information management systems. This includes integration of clinical data systems and pharmacy management systems.

Right to Care Health Services

Right to Care Health Services, a wholly owned subsidiary of Right to Care, offers organisations a comprehensive integrated wellness programme. The programme includes health and wellness screening, health risk assessments, management of chronic diseases, psychological counselling, legal and financial counselling, primary and occupational healthcare services, executive wellbeing, absenteeism, and incapacity and disability management. Clients are provided with comprehensive and integrated reports on all aspects of employee healthcare.


Right to Care’s Training Department develops staff knowledge and skills in order to improve the capacity to provide quality HIV care, treatment, and support. Training courses covering a broad range of clinical subjects are offered to healthcare providers of supported sites. Didactic training is follow up with on-site mentoring.

Skills programmes are conducted for lay counsellors and for non-clinical staff.

Corporate governance

Right to Care is governed by a board of directors, of whom two-thirds are non-executive directors. The organisation complies with King III standards of corporate governance.

Right to Care consistently achieves unqualified audits from its auditing firm, Deloitte and Touche.


Our Vision & Mission

Our Vision

That every individual will have ready and affordable access to quality evidence-based medical services

Our Mission

To respond to public health needs by supporting and delivering innovative, quality healthcare solutions, based on the latest medical research and established best practices, for the prevention, treatment, and management of infectious and chronic diseases


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