Assessment of the scale‐up of cervical cancer screening in Abidjan stratified by HIV status

• Published in: International journal of gynecology and obstetrics 2019-11, Vol.147 (2), p.246-251
• Main Authors: Boni, Simon, Tchounga, Boris, Comoe, Kouassi, Guie, Privat, Adié, Mesmin, Horo, Apollinaire, Messou, Eugène, Ekouévi, Didier K., Dabis, François, Adoubi, Innocent, Jaquet, Antoine
• Format: Article
• Language: English
• Subjects: Adult; Cervical cancer; Cote d'Ivoire - epidemiology; Cryotherapy; Cryotherapy - statistics & numerical data; Early Detection of Cancer - methods; Female; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; Humans; Mass Screening - statistics & numerical data; Retrospective Studies; Screening; sub‐Saharan Africa; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - therapy; Visual inspection
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.12959

Objective To report the successes and challenges of scaling up a population‐based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. Method A retrospective analysis of characteristics, outcomes, and follow‐up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. Results Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the “see‐and‐treat” approach. The 1‐year follow‐up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6–3.1). Conclusion Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow‐up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems. Despite successful expansion of cervical cancer screening from HIV clinics to other healthcare facilities, screening coverage of the targeted population remains low in Abidjan.