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Nivi Increases Access to HPV Testing, Vaccination, and Cervical Cancer Treatment in Key Populations

Image from University of Michigan Health Lab
Cervical Cancer and HPV are a Problem

January is cervical cancer awareness month, an important time to educate and inform others about the causes and symptoms of cervical cancer, and — most importantly — its prevention. Every year, nearly 600,000 women are diagnosed with cervical cancer globally; and every year, about half that number die from it. Unfortunately, experts predict that statistic will increase by a whopping 42% over the next decade, with most of those deaths taking place in sub-Saharan Africa. The tragedy of such a prediction? Cervical cancer is almost entirely preventable. According to the CDC, 93% of all cervical cancer can be avoided with two tried-and-true preventative measures: cervical cancer screenings and HPV vaccination. Luckily, Nivi’s digital health intervention, askNivi, provides users around the world with a window to both.

Human papillomavirus, or HPV, represents a group of viruses that are commonly spread through intercourse. HPV spreads through oral, anal, or vaginal sex, as well as skin-to-skin contact. It’s highly transmissible; in fact, most adults have HPV, regardless of their country of residence. What makes this so alarming is that, unlike other sexually transmitted infections (STIs), HPV is oncogenic. Of the more than one hundred strains of HPV, fourteen are known to cause cancer — from cancer of the throat to cancer of the penis, anus, vulva, and vagina.

According to the CDC, “HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and 60% of penile cancers.”

Cervical Cancer Mortality is Highly Inequitable

HPV is an essential women’s health issue because of its relationship to cervical cancer. Not all HPV causes cervical cancer, but virtually all cervical cancer is caused by HPV — and the disparity between cervical cancer death rates in high-income countries and those of low- and middle-income countries (LMICs) is significant. According to the International Agency for Research on Cancer, globally, cervical cancer is the seventh most common cancer and the ninth most common cause of cancer death. For women alone, it’s the fourth most common cancer as well as cause of cancer death. But unlike other cancers, nearly all deaths caused by cervical cancer occur in LMICs (approximately 90%).

In fact, a map depicting countries with the highest rates of total cancer deaths is a near-perfect inversion of a map depicting countries with the highest rates of cervical cancer deaths. It’s admittedly counterintuitive; but of the 20 countries with the highest rates of cervical cancer death, none are among the 50 countries with the highest rate of death caused by all types of cancer.

Countries with the highest rate of total cancer deaths per 100,000 people.

Countries with the highest rate of cervical cancer deaths per 100,000 women.

Reasons for this trend are multifold. Firstly, due to infrastructure and financial constraints, countries with high prevalence of cervical cancer tend to have worse health outcomes, overall. In the same vein, countries with high prevalence of cervical cancer tend to have a higher prevalence of HIV, as well — and women living with HIV are six times more likely to develop cervical cancer after HPV infection than women without HIV, due to HIV’s detrimental impact on the human immune system. Finally, access to, and distribution of, HPV vaccines is a barrier in LMICs. Although three vaccines have been approved, worldwide, to protect against HPV 16 AND 18 — the two HPV strains responsible for over 70% of all cervical cancer — uptake is lower in LMICs, confounded by low competition of HPV vaccine manufacturing, which has contributed to higher cost of care.

“It is vital that governments address these barriers…in many countries, women are often the only breadwinners, and therefore protecting them is of huge human and economic importance.”

Digital Solutions Scale to Meet the Need

Luckily, new digital tools are beginning to bridge the gap between education, prevention, screening, and cervical cancer treatment. According to the World Health Organization, the most effective interventions for cervical cancer include HPV vaccination, sex education, condom promotion and provision, HPV screening, and treatment. All of these, and more, are accessible via the askNivi platform — a free, anonymous service that recommends points of care by the user’s self-reported geographic location.

A screenshot of askNivi’s chat-based HPV menu in Kenya.

With its heavy emphasis on sexual and reproductive health (though actively expanding to other health areas), askNivi is perfectly suited to educate its users on the prevention of all sexually transmitted infections (STIs), including HPV. In addition to partners like Pathfinder Kenya using askNivi to educate communities on HPV and cervical cancer awareness, and Marie Stopes Kenya using askNivi to promote cervical cancer screening in and treatment at brick-and-mortar health clinics, other partners like the e-pharmacy Kasha serve as referral points to connect Nivi users with excellent preventative resources at digital speed — even delivering condoms and other barrier methods directly to the user’s door.

Nivi’s automated health chatbot service, askNivi, provides anyone with a mobile phone or internet access with a free, private, interactive information center that uses behavior change methodology to encourage users to take advantage of the wide variety of health products and services available via its virtual marketplace — including HPV vaccination, HPV testing, and cervical cancer screening and treatment.

By simply engaging with askNivi through Facebook Messenger or WhatsApp, users can learn about the HPV vaccine, cervical cancer signs, symptoms, and screening, how to lower one’s risk, as well as common myths and misconceptions surrounding HPV. And because HPV and cervical cancer are such burdens in LMICs — where askNivi operates — increasing the availability of, and access to, HPV screenings will likely have an enormous impact on both the incidence of cervical cancer as well as cervical cancer deaths.


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