Every year approximately 283,439 women die from cervical cancer, with over 90% of those deaths occurring in low-and middle-income countries (LMICs)1. Nearly all cervical cancers are preventable through vaccination against human papillomavirus (HPV), the virus that causes nearly all cervical cancers, or by screening for and treatment of precancerous lesions among women already infected with HPV. While deaths from cervical cancer have declined dramatically in high-income and some middle-income countries, cervical cancer mortality has continued to increase in developing countries. At current trajectories, cervical cancer is projected to cause an estimated 443,000 deaths globally in 20302. To reduce the incidence and mortality of cervical cancer in developing countries, the U.S. Agency for International Development (USAID) seeks to generate evidence that will inform national and global efforts to scale-up effective and efficient screening and treatment programs. To meet this goal, and in furthering its commitment to increasing women’s access to quality voluntary family planning and women’s health care, USAID is seeking innovative approaches to increasing cervical cancer screening and preventive therapy (CCS&PT) through introduction of new technologies and integration with voluntary family planning programs.
Through the Partnerships for Enhanced Engagement in Research (PEER), USAID will partner with the U.S. National Academies of Sciences, Engineering, and Medicine (hereafter referred to as the National Academies) and other key U.S. Government agencies to facilitate the introduction and scale-up of innovative CCS&PT approaches that can be implemented in conjunction with voluntary family planning activities, with a focus on generating evidence that will inform sustainable scale-up of cervical cancer control programs in LMICs. A primary focus of this partnership will be to leverage longstanding investments in voluntary family planning programs, as well as other efforts to address cervical cancer, and to build capacity in partner countries to sustainably address the burden of cervical cancer.
PEER is a USAID-sponsored program implemented by the National Academies. Since its inception in 2011, PEER has supported more than 300 research projects on multiple topics led by developing country investigators in USAID priority countries. The umbrella program is designed to support research capacity building and partnerships between developing country investigators and U.S. researchers. In addition, nine science agencies from the U.S. federal government currently participate in PEER, including the U.S. National Institutes of Health within the U.S. Department of Health and Human Services (HHS/NIH), which serves as a founding partner. More information can be found online at the PEER program website.
USAID has designated funding to the PEER program to support work in Malawi and Mozambique, two countries with some of the highest cervical cancer burden and mortality in the world. These efforts will focus on testing and identifying efficient and scalable implementation models of CCS&PT interventions within voluntary family planning programs in ways that optimize the uptake and health impact of both services. More information on these two countries can be found in Appendix I: Country Information.
Funds will support work in Malawi and Mozambique to identify efficient and scalable implementation models of integrating CCS&PT interventions within voluntary family planning programs. For the purposes of this solicitation, CCS&PT includes screening for and ablation of cervical pre-cancerous lesions, or, when required, enabling adequate referrals to services for evaluation of high-grade or potentially cancerous lesions. Funds can also support other non-ablative procedures (i.e., loop electrical excision procedure) at referral sites to remove precancerous lesions. Additional information on activities that may/ may not be funded under this award can be found below. Integration will be defined as clients having same-visit access to both quality voluntary family planning information and services and CCS&PT services, provided by one provider or multiple providers working as a team.
All applicants are required to include a strong monitoring and evaluation component that will effectively capture the impact of integrating these services on access and uptake of CCS&PT, as well as on quality counseling and uptake of voluntary family planning. It is expected that part of this effort will include supporting the testing and introduction of new technologies that increase the quality and efficiency of CCS&PT programs. Given the need to test and evaluate approaches and technologies at significant scale, it is expected that most of the funding under the program will be used to support implementation of integrated CCS&PT services at a large number of sites in Malawi and Mozambique, although a substantial amount will be allocated toward research studies embedded within the implementation. Site selection should be determined through consultations to identify country and program needs but should also consider inclusion of sites where access to care for large numbers of women can be increased by capacity building. With regard to new technologies, particular interest will be given to testing innovative approaches that increase access and availability of HPV-DNA testing, technologies that increase efficiencies in triage, and more portable, affordable technologies for ablation of precancerous lesions.
In its partnership with the National Academies, USAID will advance global engagement through the provision of funds to the National Academies to support partnerships between U.S. Government-supported researchers, local partners, and other partners with significant experience and capacity in service delivery of voluntary family planning and CCS&PT in Mozambique, Malawi, and/or other low-income countries in sub-Saharan Africa. These partnerships will implement promising high-quality research projects related to the integration of CCS&PT within existing voluntary family planning programs in Malawi and Mozambique. The activities proposed under these awards will support capacity building, as appropriate, across both static and mobile outreach service delivery platforms. The activities will also be implemented within country-level guidelines, policies, plans, and strategies and can be used to inform other country and donor-led investments in the scale-up of efficient CCS&PT, both nationally and globally. To ensure results inform national-level decision-making, partners should also regularly meet with, and incorporate guidance from, Ministries of Health and other relevant national and global-level policymaking and normative bodies.
To ensure efficient implementation, academic or research institutions funded through this announcement will be required to partner with one or more additional implementing organizations (U.S., international, or local) that have collectively demonstrated strong experience in delivering both voluntary family planning and CCS&PT interventions in LMICs in sub-Saharan Africa, ideally in diverse regions of Malawi or Mozambique, though experience in other contexts that share similar characteristics would also be applicable. U.S. institutions, as well as any non-local non-governmental organizations (NGOs), that receive funding through this announcement will be expected to invest in building the institutional capacity of local organizations. This includes building capacity to implement programs, conduct high-quality research, analyze data, and apply the findings to improve programs.
In their applications, prospective partners will be expected to demonstrate how requested funding from PEER is complemented by non-U.S. Government funding for cervical cancer prevention (including screening and vaccination) and treatment in that country. Applicants should also seek to leverage and build upon existing programmatic and research investments by HHS/NIH, USAID, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and other U.S. Government agencies.
It is estimated that a maximum of U.S. $5,100,000 of funding will be allocated for each country. While this is a best estimate, the competitive procurement process will likely elicit multiple proposals, and ultimately, funding decisions will be based upon several factors, including proposals’ quality and feasibility, the strength of the relationship between local and US scientists, the capacity of the partner organizations and countries to implement activities, and how well proposed activities respond to the technical and programmatic scope of the program and meet the partner country needs.
1Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2016. Geneva, World Health Organization; 2018.