Nepal

Nepal-1Principal Investigator: Sadeep Shrestha, PhD, MHS, MS – Department of Epidemiology, University of Alabama at Birmingham, USA

Co-investigators:

  • Pema Lhaki, MA, NFCC International, Lalitpur, Nepal
  • Sarita Ghimire, MD, Cancer Screening Center, Nepal Cancer Care Foundation, Lalitpur, Nepal
  • Shilu Aryal, MD, Family Health Division, Kathmandu Nepal
  • Patricia Vuichard, MD, Lukla Hospital, Solukhumu, Nepal & Foundation Nicole Niquille Hospital Lukla, Switzerland
  • Nicolle Niquille, Lukla Hospital, Solukhumu, Nepal & Foundation Nicole Niquille Hospital Lukla, Switzerland
  • Madhav Bhata, Kent State University, Kent, Ohio
  • Location: Nepal

In countries like Nepal, where screening is not implemented, cervical cancer (CC) is usually detected when it is already at an advanced stage and even then effective treatment is not available, resulting in high mortality. Currently, there is no national screening program in Nepal. The lack of access to general gynecologic services, and preventive gyneco-oncologic services in particular, results in most cases of cervical cancer in Nepali women being undiagnosed and untreated. Prevention strategies for cervical cancer, including both vaccination and screening for human papillomavirus (HPV) will save lives. While an effective HPV vaccine has been developed, barriers due to limited financial resources have hindered access for this vulnerable population. Further, before implementing these programs in a rural and resource-limiting areas in Nepal, it is important and necessary to know the prevalence, incidence of HPV infection and distribution of the various HPV types in various populations in Nepal. A successful HPV and cervical cancer program requires mobilizing and educating communities, organizing services to meet women’s schedules and needs, and strengthening systems to track clients for follow-up and treatment.

Dr. Shrestha and his team at the University of Alabama at Birmingham (UAB) have established strong collaborations with a local NGO, Nepal Fertility Care Center (NFCC) (http://nfccint.org/what-we-do-page/hpv-cervical-cancer) directed by Ms. Pema Lhaki, which also has a liaison office in New York. Collaborations have also been established with various other organizations in Nepal that have helped to initiate an HPV/CC screening program.

Dr. Shrestha and the team have three ongoing projects – the specific aims of each project are described below.

  1. Using Mobile Health (mHealth) Technologies to Ensure Continuum of Care in Cervical Cancer Screening in the Kailali District of Nepal (PI: Sarita Ghimire) – funded by Conquer Cancer, American Society of Clinical Oncology.

Nepal-2The specific aims of the study are:

  1. To develop a user-friendly mHealth methodology to inform and implement mobile phone text messaging systems to: a) register; b) make referrals based on results; and c) follow-up on referral visits.
  2. To evaluate and monitor the rate of follow-up referrals for cervical cancer screening using mHealth.

 

  1. The Risk Factors and Distribution of Human Papillomavirus (HPV) in two development Regions.

The specific aims of the pilot study are:

  1. a) To determine the prevalence of high-risk HPV (HR-HPV) infections among women in in different populations in geographically diverse Development Regions.
  2. b) To identify the social, behavioral, and demographic factors associated with HR-HPV infections among women attending health camps in 5 Development Regions.

 

III. Evaluation of HPV screening outcomes in the Solukhumbu district

The specific aims of the proposed study are:

  • To identify and screen all women between the ages of 30-60 years for HPV living in the district.
  • To establish and maintain a strong and sustainable referral system for post-screening treatment and continuum of care.