Screen-and-Treat Approach to Cervical Cancer Prevention Using Visual Inspection With Acetic Acid and Cryotherapy: Experiences, Perceptions, and Beliefs From Demonstration Projects in Peru, Uganda, and Vietnam

Abstract

Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA andcryotherapyintoroutineservices.Resultsshowedthatuseof VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Althoughsomechallengeswerefoundacrossallsites,othersvaried from country to country, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success. The Oncologist 2013;18: 1278 -1284 Implications for Practice: Government-run cervical cancer screening programs in Peru, Uganda, and Vietnam showed that using visual inspection with acetic acid (VIA) and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help to ensure success include mobilizing and educating communities, organizing services to meet women's schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. While some challenges were found across all three countries, others varied, suggesting that careful assessments before beginning new secondary prevention programs will optimize the probability of success.

Knowledge, Attitudes and Behavior of Bangkok Metropolitan Women Regarding Cervical Cancer Screening

“…After a discovery of human papilloma virus (HPV) as the cause of cervical cancer (zurHausen, 1977), HPV DNA testing has become an effective means of screening (Saslow et al, 2012). Another practical test in low resources setting, where cervical cytology of HPV test are inadequate or unavailable, is visual inspection with acetic acid (VIA) (Sankaranarayanan et al, 2003;Gaffikin et al, 2003;Sanghvi et al, 2008;Paul et al, 2013;Bradford and Goodman, 2013). Several countries have set guideline in the screening program including important issues e.g.…”

Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review

“…In these studies, implementation science contributed significantly or was the primary focus in the development of the research questions. Various methodologies may be used, such as participatory research, mixed methods, or observational studies, but implementation variables are either primary outcomes or independent variables Examples: Effectiveness implementation trials, participatory research, Mixed methods or quasi-experimental studies evaluating changes in delivery or acceptability, Observational studies with implementation as secondary factors or focused on adaptation, learning, and program scaling Principally, those contexts include in-depth perspectives on acceptability and community perceptions [53], community education and mobilization [30,59] including radio messaging [41], community-focused or mobile screening [30,58], detail on training community health workers [50], client tracking [59], maintenance of human capacity [59], task sharing [65], and quality control [70]. These findings are accessible and highly applicable to the existing programs struggling with substantial challenges as well as to institutions that are prioritizing the new implementation of cervical cancer screening services.A large study in 130 rural communities in Guangdong Province, China [69] employs sound Dissemination and Implementation research methods.…”

Efficacy, Safety, and Acceptability of Thermal Coagulation to Treat Cervical Intraepithelial Neoplasia: Pooled Data From Bangladesh, Brazil and India

“…2017;6(3-4):58-64 services, particularly in many sub-Saharan African countries. This approach has been shown to be acceptable, safe, efficacious and feasible in demonstration projects and large-scale national or regional programs are on-going in countries such as Thailand and Zambia [4,6,7,[17][18][19][20]. Recently a screen-andtreat approach using thermal coagulation has been evaluated in a large screen-and-treat field program in Malawi, in which thermal coagulation for treatment of VIA-positive lesions was introduced as an alternative to cryotherapy [21].…”