Implementation and Outreach

CAPE: Cervical Cancer Prevention in El Salvador

Cytology (pap smear) programs have not decreased mortality from cervical cancer in Low and middle income countries (LMICs). These programs are not feasible in LMICs because they require highly trained staff and a sophisticated infrastructure.

In 2012, BHI partnered with the Salvadoran Ministry of Health (MINSAL) to introduce low-cost HPV testing, which is potentially a more effective screening strategy in these settings. CAPE was a phased demonstration project that screened more than 28,000 women.

Analysis of this project showed that a screen and treat strategy using HPV testing was both clinically effective and less costly than conventional programs. The demonstration project was so successful that the Ministry of Health decided to use this strategy as they scaled-up cervical cancer screening and treatment nationally.

To implement this scale-up, the Salvadoran Ministry of Health (MINSAL) has secured one million dollars to integrate the CAPE paradigm into the public health system beginning in 2018. BHI will continue to act as a technical advisor in for this countrywide initiative.

Lastly, in collaboration with MD Anderson Cancer Center, a five-year follow-up will be conducted on the women who were screened in the CAPE project beginning in 2012, in order to find out how providing HPV testing with immediate treatment impacted the prevalence of disease in El Salvador. These interventions will help inform other programs on how to achieve an impact on the prevention of this disease.

CAPE Team

Dr. Javier Ayala

Project Supervisor

Dr. Ayala graduated from Universidad Nacional de El Salvador as a Doctor in Medicine. He has been part of Basic Health International since July 2018 as the supervisor of our CAPE project in the Western region of El Salvador.

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Dr. Javier Ayala

Project Supervisor

Dr. Ayala graduated from Universidad Nacional de El Salvador as a Doctor in Medicine. He has been part of Basic Health International since July 2018 as the supervisor of our CAPE project in the Western region of El Salvador. He worked as a family doctor in the coastal region of La Libertad, where he volunteered as a physician at Cruz Roja Salvadoreña.

Dr. Fredy Mendez

Project Supervisor

He is a Physician graduated from Universidad Nacional de El Salvador, with a degree in Family Medicine and also has a Master’s in Public Health and Epidemiology from Universidad Evangélica de El Salvador.

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Dr. Fredy Mendez

Project Supervisor

He is a Physician graduated from Universidad Nacional de El Salvador, with a degree in Family Medicine and also has a Master’s in Public Health and Epidemiology from Universidad Evangélica de El Salvador.

He’s been working at Basic Health since 2014, as a medical supervisor in the implementation of the screening program with HPV CARE test; in the paracentral region of El Salvador. He’s in charge of the Cuscatlán department. In Cuscatlán, the program has been successfully developed. Also, early technology and treatment for cervical cancer prevention has been introduced. He supervises the intake and the follow-up of patients with HPV positive diagnoses. He’s currently working on implementing screening resources in the western region of El Salvador, specifically in the department of Ahuachapán.

Dr. Juan Carlos Rauda

Project Coordinator

Dr. Rauda received his Doctor in Medicine degree from Universidad de El Salvador, and recently graduated from his Masters in Epidemiology from Universidad Evangelica de El Salvador. He worked at the Ministry of Health as a community doctor in the department of Chalatenango.

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Dr. Juan Carlos Rauda

Project Coordinator

Dr. Rauda received his Doctor in Medicine degree from Universidad de El Salvador, and recently graduated from his Masters in Epidemiology from Universidad Evangelica de El Salvador. He worked at the Ministry of Health as a community doctor in the department of Chalatenango. He subsequently served as a consulting physician at the Professional Development Organization (OPRODE); providing medical and psychological assistance in low-resource communities in the central area of El Salvador.

In 2014, he started working at Basic Health International as supervisor of the CAPE phase 3 project in the department of La Paz. He is currently monitoring the implementation of the CAPE project in the Western and Eastern regions of the country.

Dr. Jose Roberto Perez

Project Supervisor

Dr. Roberto Pérez graduated from the University of Nueva San Salvador; he also graduated with a Senior Management degree at FEPADE and Data for Decision Making at the University "José Simeón Cañas". He took a Basic Principles of Epidemiology course of the CDC.

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Dr. Jose Roberto Perez

Project Supervisor

Dr. Roberto Pérez graduated from the University of Nueva San Salvador; he also graduated with a Senior Management degree at FEPADE and Data for Decision Making at the University "José Simeón Cañas". He took a Basic Principles of Epidemiology course of the CDC. He worked in the Ministry of Public Health in the Advanced Project COPRECOS and Breastfeeding Support Center. He is currently professor of Epidemiology at the Universidad Católica de El Salvador.

He began working with Basic Health International in 2014 as a Supervisor Physician for the CAPE Project in the Department of San Vicente. He currently supervises the Eastern Region of the Country that comprises the Usulután, San Miguel, Morazán and La Unión Departments.

Self - Sampling El Salvador

A total of 1,867 women performed self-sampling and over 90% of women with abnormal results received and adequate treatment.

With the support of the Rising Tide Foundation, BHI’s self-sampling research project ended in December, 2017. A total of 1,867 women performed self-sampling and over 90% of women with abnormal results received adequate treatment. This project helps to confirm that this innovative, community-based method of screening for cervical cancer offers a viable alternative to the vulnerable population of women who would not otherwise have access to care.

Haiti

The study involves having approximated 3,000 women perform HPV self-collection. The women's who are HPV-positive will then be treated with thermoablation, which uses heat to treat cervical pre-cancer. The Celgene research project examines the feasibility and acceptability of HPV self-collection and thermoablation in both a rural and urban setting and will take place at two sites: the Family Health Ministries (FHM) clinic in the mountains of Tom Gato, and the St. Luke's/BHI clinic in Port-au-Prince.