HPV, STI and AMR in West Africa: estimating population burden and understanding exposures to accelerate vaccine impact and drive new interventions

联合国可持续发展目标3（SDG3）为到2030年改善全球健康和福祉设定了雄心勃勃的目标。这包括减少因癌症早死人数和因可预防原因死亡的新生儿人数的目标。它包括大幅度减少B型肝炎和C型肝炎感染人数的目标，以及阻止所有艾滋病毒从母亲传给婴儿的目标。该目标还要求普及性保健和生殖保健。其中许多领域对妇女的健康和福祉产生了不成比例的影响，使性别不平等现象更加严重。这与旨在减少这种不平等的可持续发展目标5的目标相冲突。如果要实现冈比亚和西非其他地区的妇女目标，就必须大幅增加进展。最近的一项审查强调，迄今为止进展过于缓慢的主要原因之一是缺乏关于特定健康状况负担的可靠信息。与世界其他地区相比，这是西非的一个特殊问题。拟议的调查将专门解决这一问题，旨在推动冈比亚和西非其他地区妇女健康和福祉的关键领域的改善，具体如下：性传播的人乳头瘤病毒（HPV）导致宫颈癌，这是非洲妇女癌症死亡的最常见原因之一。已经有一种针对HPV的疫苗，已被证明在高收入国家的妇女中预防癌症非常有效。该疫苗将在冈比亚引入，现在必须能够监测它在西非的效果。测量冈比亚女性在引入疫苗之前有多少HPV是至关重要的，也是调查的一个重要目标。可能有更好或更容易的方法来接种HPV疫苗，并且改进的疫苗也可以使用。如果我们要预测和衡量这一情况，并最终减少西非妇女死于宫颈癌的人数，那么调查中的信息是必不可少的。其他性传播感染，包括梅毒、淋病和衣原体，是可预防的新生儿死亡、死产、不孕症和其他性健康和生殖健康问题的重要原因。对于淋病等感染，世界上一些地区对许多抗生素的耐药性也在增加。我们不知道这个问题在西非有多大。这项调查将衡量冈比亚女性中性传播感染和抗生素耐药性的常见程度。这些信息将首先，改善我们在冈比亚和西非其他地区治疗性传播感染的方式，其次，推动新的感染检测方法的发展，以及预防它们的新疫苗。B和C型肝炎是西非肝癌的主要原因。B型肝炎可以通过接种疫苗来预防，在出生后24小时内为新生儿接种疫苗可以防止母婴传播。可以治愈丙型肝炎的药物是可用的。还可以防止艾滋病毒从母亲传染给婴儿。要做到这一点，母亲必须知道她在怀孕期间受到感染，婴儿出生时得到药物。这项调查将衡量这三种感染在育龄妇女中的常见程度。它还旨在确定冈比亚卫生系统中的因素，这些因素意味着现有的有效预防和治疗战略要么不存在，要么没有得到正确执行。总之，计划调查的信息旨在加快关键领域实现可持续发展目标3的进展，从而对西非妇女的健康和福祉产生急需的积极影响。

United Nations Sustainable Development Goal 3 (SDG3) sets ambitious targets for improving health and wellbeing globally by 2030. This includes targets for reducing the number of people dying early from cancer, and the number of newborns dying for preventable reasons. It includes targets for dramatically reducing the number of hepatitis B and hepatitis C infections, and for stopping all cases of HIV being passed from a mother to baby. The goal also calls for universal access to sexual and reproductive health care. Many of these areas disproportionately impact on the health and wellbeing of women and make gender inequality worse. This conflicts with the aims of SDG5 which aims to reduce such inequality.If the targets for women in The Gambia and other parts of West Africa are to be achieved, a dramatic increase in progress is essential. A recent review highlighted that one of the main reasons that progress has been too slow so far, is a lack of reliable information on the burden of given health conditions. This was found to be a particular problem in West Africa compared to other parts of the world. The proposed survey will specifically address this and aims to drive improvements in key areas for the health and wellbeing of women in The Gambia and other parts of West Africa as follows:Human papillomavirus (HPV), which is sexually transmitted, causes cervical cancer, one of the most common causes of cancer death in women in Africa. There is already a vaccine against HPV which has been shown to be very good at preventing cancer in women in high income countries. The vaccine is going to be introduced in The Gambia and it is now essential to be able to monitor how good it is in West Africa too. Measuring how much HPV females in The Gambia have before the vaccine is introduced is critical for this and is an important aim of the survey. It may be that there are better, or easier, ways to give HPV vaccines and that improved vaccines become available too. The information from the survey is essential if we are to predict and measure this and ultimately reduce the number of women dying early from cervical cancer in West Africa.Other sexually transmitted infections (STIs), including syphilis, gonorrhoea, and chlamydia, are important causes of preventable deaths in newborns, of stillbirths, of infertility and of other sexual and reproductive health problems. For infections like gonorrhoea, resistance to many antibiotics is increasing too in some parts of the world. We do not know how big a problem this is in West Africa. The survey will measure how common STIs and antibiotic resistance are in females in The Gambia. This information will first, improve the way we treat STIs in The Gambia and other parts of West Africa and second, drive the development of new tests for the infections, and new vaccines to prevent them.Hepatitis B and C are the leading causes of liver cancer in West Africa. Hepatitis B is preventable by vaccination and providing the vaccine to newborns in the first 24 hours of life prevents the infection being transmitted from mother to baby. Medicines that can cure hepatitis C are available. It is also possible to prevent HIV being transmitted from mother to baby. To do this it is essential the mother knows she has the infection during pregnancy and that the baby is given medicines when it is born. The survey will measure how common these three infections are in women of childbearing age. It also aims to identify those factors in the Gambian health system that mean the effective prevention and treatment strategies which exist are either not available or not implemented correctly.In summary, information from the planned survey aims to accelerate progress towards SDG3 in key areas and thus will have much needed positive impact on the health and wellbeing of women in West Africa.