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Evaluation of a single‐visit approach to cervical cancer screening and treatment in G uyana: Feasibility, effectiveness and lessons learned
Author(s) -
Martin Caitlin E.,
Tergas Ana I.,
Wysong Megan,
Reinsel Maureen,
Estep Deborah,
Varallo John
Publication year - 2014
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12366
Subject(s) - medicine , cryotherapy , cervical cancer , visual inspection , psychological intervention , incidence (geometry) , family medicine , cancer , physical therapy , nursing , surgery , statistics , physics , mathematics , optics
Aim To evaluate a cervical cancer prevention project in G uyana utilizing visual inspection with acetic acid ( VIA ) and immediate cryotherapy in a single‐visit approach; and to identify lessons learned to inform the improvement of cervical cancer prevention programs in G uyana and other low‐resource settings. Methods Service records from J anuary 2009 to J une 2012 were analyzed for 18 cervical cancer prevention sites across G uyana. Records included women's HIV status, data on visual inspection with acetic acid screening and treatment status for women's initial and 1‐year follow‐up screenings, provider training and retention. A process evaluation was conducted in 2011 to identify programmatic strengths and interventions for integration, scale‐up and sustainability. Results During the 42‐month interval, 21 597 new screenings were performed, reaching 95% of HIV + women enrolled in care and 17% of women aged 25–49 years in G uyana. The VIA + rate was 13% ( n = 2806); 85% of women eligible for cryotherapy received immediate treatment. Half of VIA + women treated with cryotherapy or loop electrosurgical excision procedure returned for a 1‐year follow‐up screening ( n = 1027); 95% were VIA – at the second screening. Non‐physician providers were more likely to continue offering services than physicians. Most programmatic challenges were related to systemic rather than technical/clinical issues. Conclusion The single‐visit approach‐based program is feasible, effective, and when scaled up, likely to have an impact on overall incidence of cervical cancer. Services can be shifted to non‐physicians for scale‐up of high‐quality cervical cancer prevention services nationally. To ensure sustainability and expansion, support structures should be prioritized.