Rwanda CASCADE Clinical Trials Site for cervical cancer prevention

Cervical cancer is a highly preventable malignancy caused by high-risk human papillomavirus (hrHPV) but is not fully prevented, especially in low- and middle-income countries (LMIC). Women living with HIV (WWH) have higher rates of hrHPV infection and 6-fold higher rates of invasive cervical cancer. Sub-Saharan Africa carries the highest burden of cervical cancer globally, as well as the highest global burden of HIV. The Einstein/Rwanda Research and Capacity Building Program (ER-RCBP) has been conducting research in cervical cancer prevention for Rwandan WWH since 2005, conducting community- and clinic-based research in screening uptake, screening modalities, assessing HPV vaccine effectiveness, evaluating how to implement innovative screening approaches, and developing pathology and molecular laboratory capacity. We have enrolled nearly 10,000 women WWH and 3,000 HIV-negative women in studies of cervical HPV infection and disease. ER-RCBP’s primary partner in this application, and in prior research in HIV services and cervical cancer prevention, is the Rwanda Biomedical Center (RBC), the implementation arm of Rwanda’s Ministry of Health for healthcare delivery and research. Rwanda has an extremely effective HIV healthcare program, an equally effective program for HPV vaccination of girls, and has recently launched a cervical cancer screening and prevention program with primary HPV testing followed by visual inspection of the cervix and immediate treatment with thermal ablation, if indicated, for screen-positive women. Rwanda is thus an ideal location for testing strategies for effective cervical cancer screening in a low-income country with a high burden of HIV, cervical cancer, and a large unscreened population. We propose here a clinical trials site in Rwanda as part of the CASCADE Clinical Trials Network for Cervical Cancer Prevention. Lessons learned in Rwanda can be generalized to many low-income countries in sub-Saharan Africa.