Building Capacity to Stop HPV Infection

SSI has worked for over 20 years strengthening human papilloma virus (HPV) detection and treatment in Central and South America – which has the second highest HPV prevalence in the world – by building scientific capability and, more recently, by developing access to primary care for indigenous women.

Since 2011, SSI’s Capacity Building program has trained 50 clinicians and technicians, and helped build laboratories to screen for HPV viruses using sensitive molecular methods in El Salvador, Guatemala and Honduras. With this new evidence of viral burden, focused treatment and vaccination campaigns were launched.

SSI’s Capacity Building program, led by Scientific Director Dr. Maria Elena Peñaranda, collaborates with in-country partners and US-based academic institutions and is funded by partnerships with local institutions (National Secretariat for Science and Technology of Panama or SENACYT) and private donations (Conservation Food and Health Foundation, Abundance Foundation, and generous individuals).

In 2020, SSI began collaborating with QuinaCare, a non-profit primary care provider in the Ecuadorian Amazon. In 2023, SSI launched its newest program, BIENSUR, to provide care – including HPV testing and treatment – to indigenous Ecuadorian women in collaboration with another pioneering non-profit, Fundación Hospital de los Valles.

Increasing Capacity for HPV Testing

SSI’s HPV initiative began in San Salvador, El Salvador with delivery of donated laboratory equipment and reagents worth $25,000 (from the Univ. of California and Roche) coordinated by SSI’s material donations program. With the donations, the University of El Salvador’s School of Medicine outfitted a clinical lab under the supervision of Dr. Penaranda who also trained 12 clinicians and researchers on HPV molecular virology diagnostic techniques. A follow-up visit 6 months later showed that, even though the trainees had little prior experience with molecular assays, they were able to learn the techniques in the week-long intensive training and apply them in their work. This initiative increased motivation to conduct HPV testing, and sparked multi-center collaborations among the University of El Salvador, the Universidad Dr. Jose Matias Delgado and El Salvador’s Ministry of Public Health (MINSAL).

The next year, in Quetzaltenango, Guatemala, SSI helped organize another laboratory, funded by The Global Fund, and taught molecular virology techniques at IDEI (the Asociación Investigación Desarrollo y Educación Integral). IDEI, with the Hospital Rodolfo Robles, serves northwest Guatemala’s population of indigenous Mayan peoples who have little access to care. Here, SSI trained 38 clinicians and technicians on HPV diagnostic techniques in 2012 and 2013. This screening and diagnosis program was continued by one of SSI’s trainees, Alejandra Castillo M.S., the head microbiologist at IDEI, who manages the laboratory and technicians. In 2017, at the invitation of Ms. Castillo, Dr. Peñaranda returned to Guatemala to train 5 technicians in new methods to improve detection of HPV and Zika virus, and to review the standard operating procedures in the laboratory. A few years later, SSI and Dr. Jesse Waggoner (Emory University, School of Medicine) provided IDEI with Real-Time PCR (polymerase chain reaction) equipment.

In 2014, in Tegucigalpa, Honduras, Dr. Peñaranda and Dr. Joel Palefsky (UC San Francisco) conducted a lab training on HPV testing for 10 clinicians and technicians with the Universidad Nacional Autónoma de Honduras (UNAH). This effort was led by Dr. Annabelle Ferrero of UNAH who obtained the funding and organized the trainings. This collaboration led to a proposal demonstrating to the Honduran government that HPV testing was financially and logistically feasible.

As researchers and clinicians gained access to new techniques, they sought funding for further surveillance, diagnostic and treatment activities. To meet this need, SSI provided grant and manuscript writing workshops focusing on HPV and HIV. From 2013-14, HPV-focused writing workshops were held in Quetzaltenango, Guatemala (16 participants), in Quito, Ecuador at the Universidad de las Americas (18 participants) and at the Universidad San Francisco de Quito (30 participants). In 2019 and 2020, Dr. Peñaranda conducted several small writing workshops in Panama City, funded by SENACYT, with a total of 50 participants, many of whom focused on HPV. These workshops allowed clinicians and researchers to obtain funding for their work on HPV/HIV, to publish their findings, and to participate in conferences.

Primary Care for Indigenous Women in Ecuador– QuinaCare and Fundación Hospital de los Valles

In 2020, the NGO QuinaCare, directed by Dr. Jacob Van der Ende, began collaborating with SSI thanks to the work of Dr. Josefina Coloma, SSI’s Exec. Director, to bring COVID-19 testing to indigenous tribes in the Ecuadorian Amazon. The collaboration has expanded, supporting development of the Hospital San Miguel (HSM) and its capacity to conduct HPV testing and provide care to improve indigenous women’s health and well-being. Opened in 2021, this hospital is located in the most remote region of Northeast Ecuador and serves the local population, Quechua people of the Amazon, who have no other access to care. Women treated at HSM are disproportionally affected by HPV and suffer from intra-familial violence and high rates of femicide.

In 2023, SSI’s newest program, BIENSUR (Bienestar Indígena Ecuatoriano en Salud Urbano-Rural) was formed. In 2023-24, as part of its project “Yo decido” (I decide), BIENSUR provided gynecological services (Pap smear, HPV test, colposcopy, genetic testing if positive, vaccines, and mammograms) to 25 marginalized Amazonian women living in a rural enclave near the Ecuadorian capital, Quito. Services were provided by a partner NGO, the Fundación Hospital de los Valles (FHDLV). Among the 25 women tested, 4 were positive for HPV and received appropriate follow-up care.

With the success of “Yo decido”, at the end of 2024, Fundación Hospital de los Valles provided these services to another 25 women from a rural parish in Quito who have had little to no access to women’s health care and are concerned about cervical cancer.