Everybody Wins: Cancer in the World of PEPFAR

This post was written by Loyce Pace Bass, MPH, Director of Health Policy and Cameron Krier, JD, MPH, Director of Federal Relations at LIVESTRONG Foundation.

Legislation recently passed to renew the President’s Emergency Plan for AIDS Relief (PEPFAR) program included language that represents an important first step in assessing emerging health threats that could impact the program. A new reporting provision requires a discussion on how countries are addressing co-infections and co-morbidities of HIV/AIDS, including AIDS-related cancers. People living with HIV/AIDS are at a higher risk for certain types of cancers, such as cervical, liver and non-Hodgkin’s lymphoma. In fact, one out of three cancers in sub-Saharan Africa is caused by an infection.

LIVESTRONG works to ensure that NCDs are a priority everywhere.

LIVESTRONG works to ensure that NCDs are a priority everywhere.

The LIVESTRONG Foundation advocated for the inclusion of this new reporting requirement and believes that the PEPFAR platform can be leveraged to strengthen overall health systems and comprehensively fulfill patient needs. Countries can then be in a better position to take ownership of addressing other diseases, like cancer, in a way that builds on the success of current investments. For example, community health workers could be cross-trained in simple prevention and diagnostic techniques, such as the use of vinegar to detect cervical cancer and onsite cryotherapy to treat it. We believe that assessing and addressing these emerging diseases impacting the PEPFAR population is key to maintaining progress within the program. The NCD Roundtable, of which LIVESTRONG Foundation is a founding member, has repeatedly called for the US Government to build upon successful global health initiatives, such as PEPFAR, to ensure a broader response to non-communicable diseases (NCDs) worldwide.   

This September marked the second anniversary of the UN High-level Meeting on NCDs, at which heads of member states agreed these diseases and their risk factors are a major global health problem and committed to strategies across the development agenda to address them. Since then, the World Health Organization (WHO) has developed a global action plan on NCDs and member states have agreed to a set of global targets to better prevent or control NCDs, including cancer, and their risk factors around the world. WHO and member states are currently in the process of developing a coordinating mechanism that, ideally, will track implementation of the global strategy and hold parties accountable to the agreed overarching goal of reducing premature deaths from NCDs globally by 25% by the year 2025.

Last week, the Union for International Cancer Control convened 250 stakeholders, including first ladies and ministers of health, from over 50 countries to propose novel cancer data, prevention, or treatment initiatives that could help achieve the new 2025 NCD goal. In particular, attendees presented innovative solutions that emphasized the integration of cancer into other global health priorities such as women’s health. Several interventions touched on how countries consider leveraging the PEPFAR platform to provide care for patients at dual risk for cancer. These more holistic approaches are essential in the new international health and development context.

As we approach 2015, the next iteration of broader global development goals is another important factor. How will NCDs (and cancer, specifically) be placed in any new framework? Arguably, cancer and its myriad risk factors such as tobacco use and unhealthy diets aren’t only a health issue but are relevant to other sectors such as agriculture or environment, urban planning or transportation, and finance or trade. The global cancer dialogue that has emerged also lends itself to how we have shifted from thinking about individual problems to patients as a whole. For example, what are the comprehensive needs of women and children – health, socioeconomic, or otherwise? Given diminishing resources for these issues across the board, it is increasingly important that we consider how best to extend current funding and platforms to advance new objectives.