Evaluation of a single-visit approach to cervical cancer screening and treatment in Guyana: Feasibility, effectiveness and lessons learned

• Published in: The journal of obstetrics and gynaecology research 2014-06, Vol.40 (6), p.1707-1716
• Main Authors: Martin, Caitlin E., Tergas, Ana I., Wysong, Megan, Reinsel, Maureen, Estep, Deborah, Varallo, John
• Format: Article
• Language: English
• Subjects: Acetic Acid; Adult; cervical cancer screening; Cryosurgery; Delivery of Health Care - methods; Feasibility Studies; Female; Guyana; HIV Infections - complications; Humans; Mass Screening; Middle Aged; service delivery; single-visit approach; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - surgery; visual inspection with acetic acid
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.12366

Aim To evaluate a cervical cancer prevention project in Guyana 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 Guyana and other low‐resource settings. Methods Service records from January 2009 to June 2012 were analyzed for 18 cervical cancer prevention sites across Guyana. 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 Guyana. 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.