scholarly journals Screen, Notify, See, and Treat: Initial Results of Cervical Cancer Screening and Treatment in Rwanda

2021 ◽  
pp. 632-638
Author(s):  
Marie-Aimee Muhimpundu ◽  
Fidele Ngabo ◽  
Felix Sayinzoga ◽  
Jean Paul Balinda ◽  
John Rusine ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Service Delivery ◽  
Cervical Cancer Screening ◽  
Health Workers ◽  
Screening Program ◽  
Public Awareness ◽  
Cervical Lesions ◽  
District Hospitals

PURPOSE To describe the first year results of Rwanda's Screen, Notify, See, and Treat cervical cancer screening program, including challenges encountered and revisions made to improve service delivery. METHODS Through public radio broadcasts, meetings of local leaders, church networks, and local women's groups, public awareness of cervical cancer screening opportunities was increased and community health workers were enlisted to recruit and inform eligible women of the locations and dates on which services would be available. Screening was performed using human papillomavirus (HPV) DNA testing technology, followed by visual inspection with acetic acid (VIA), and cryotherapy, biopsy, and surgical treatment for those who tested HPV-positive. These services were provided by five district hospitals and 15 health centers to HIV-negative women of age 35-45 and HIV-positive women of age 30-50. Service utilization data were collected from the program's initiation in September 2013 to October 2014. RESULTS Of 7,520 cervical samples tested, 874 (11.6%) screened HPV-positive, leading 780 (89%) patients to undergo VIA. Cervical lesions were found in 204 patients (26.2%) during VIA; of these, 151 were treated with cryoablation and 15 were referred for biopsies. Eight patients underwent complete hysterectomy to treat advanced cervical cancer. Challenges to service delivery included recruitment of eligible patients, patient loss to follow-up, maintaining HIV status confidentiality, and efficient use of consumable resources. CONCLUSION Providing cervical cancer screening services through public health facilities is a feasible and valuable component of comprehensive women's health care in resource-limited settings. Special caution is warranted in ensuring proper adherence to follow-up and maintaining patient confidentiality.

scholarly journals Scaling Up of Cervical Cancer Screening at Primary Health Care Level in Rwanda

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 54s-54s
Author(s):  
U. Francois ◽  
J.P. Balinda ◽  
M. Hagenimana ◽  
R. Samuel ◽  
E. Arielle ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Screening Program ◽  
Health Centers ◽  
Care Level ◽  
Primary Health ◽  
Cancer Screening Program ◽  
District Hospitals ◽  
Cervical Cancer Screening Program

Background: Rwanda is a high cervical cancer-burden country, with an age standardized rate (ASR) of cervical cancer incidence of 41.8 cases per 100,000 people in 2012. In the same year, cervical cancer mortality lay at 26.2 deaths per 100,000 people. Aim: To address this burden, Rwanda initiated the vision inspection with acetic acid (VIA) screening-based strategy in 2013 in line with WHO recommendations for low- and middle-income countries. The target audience of the program was set for women between the ages of 30 and 49 and remains today. Here, we describe the implementation status of the program at the primary health care level; health centers and district hospitals in Rwanda. Methods: Integrating into Rwanda's existing health system, the program was purposefully rooted in health centers, with a pathway designed for women who screen positive to be referred to the district hospital for cryotherapy or LEEP, according to the lesions' size. Nurses, midwives and medical officers from health centers and district hospitals are trained through a 10-day curriculum (5 days for theory and 5 days for practice) before initiating the provision of services to clients in routine care. Monitoring of the program is conducted through both quarterly, on-site mentorship and screening indicators that are integrated into Rwanda's Health Management Information System (HMIS), through which facilities report on monthly basis. Results: Since its initiation in August 2013, Rwanda's cervical cancer screening program has been established in 21 of 38 (55%) district hospitals and 256 health centers in their catchment area. Training has been an integral component as well, with at least two nurses/midwives trained at implementing health centers and a medical officer with two nurses/midwives trained on cervical cancer screening and the treatment of precancerous lesions at district hospital. In addition, district hospitals have been equipped with cryotherapy, LEEP, and colposcopy machines. Over this program's implementation three-and-a-half-year course, 38,000 women have been screened for cervical cancer. Conclusion: Using a simple VIA-based strategy, Rwanda has been able to swiftly and effectively increase the number of health facilities implementing cervical cancer screening program. Though additional innovative implementation strategies are still needed to proportionally increase women's screening coverage, these initial steps hold great promise in Rwanda's ability to effectively implement a sustainable cervical cancer screening program.

Assessing the Community Context When Implementing Cervical Cancer Screening Programs

2018 ◽  
Author(s):  
Prajakta Adsul ◽  
Purnima Madhivanan
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cultural Context ◽  
Health Workers ◽  
Screening Program ◽  
Qualitative Interviews ◽  
Community Context ◽  
Successful Implementation ◽  
Screening Programs

This case study demonstrates the use of qualitative, community-based, participatory research to understand the context in which cervical cancer screening programs are implemented in rural India, thereby enabling not just successful implementation but also future sustainability of the program in the community. A series of studies were undertaken to understand the cervical cancer screening program in its current state and provide information for the implementation of future programs. These studies included (1) qualitative interviews with physicians delivering cervical cancer care in the private and public sector, (2) focus group discussions with health workers in primary health care clinics, and (3) photovoice study with women residing in the communities. Study findings helped identify elements of the social and cultural context of rural communities, thereby providing a rich understanding of factors influencing of cervical cancer screening that can be integrated into pre-intervention capacity development in the future.

scholarly journals Cervical Cancer Screening Program in Bangladesh

2020 ◽  
Vol 33 (1) ◽  
pp. 63-73
Author(s):  
Ashrafun Nessa ◽  
Saleha Begum Chowdhury ◽  
Parveen Fatima ◽  
Mohammed Kamal ◽  
Mohammad Sharif ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Service Providers ◽  
Screening Program ◽  
Health Care Facilities ◽  
Cancer Screening Program ◽  
District Hospitals ◽  
Cervical Cancer Screening Program ◽  
The Government

Background: Cervical cancer (CC) is the fourth most common cancer in women worldwidewith an estimated 569,847 new cases and 311,365 deaths in the year 2018. In Bangladesh,the incidence of CC was 8068 and 5214 women died from CC in the year 2018.1CC constitutesabout 12% of the female cancer in this country.1 Methods: The present situation of cervical cancer screening program is reviewed. Results: The Government of Bangladesh (GOB) adopted visual inspection of cervix withacetic acid (VIA) method for cervical cancer screening. The major strengths of VIA is itssimplicity, low cost, potential for immediate linkage with investigations/treatment, feasible inlow resource settings and the possibility of rapid training to the providers. The GOB hasextended the program to all districts and selected upazilas.The screening programme hasbeen implemented through capacity building of service providers of Medical College Hospitals(MCHs), District Hospitals (DHs), Mother and Child care Welfare Centers (MCWCs) andselected Upazila Health Compleses(UHCs) and several institutes.Serviceprovidersareperforming VIA for the women of 30 years and above at about 417 VIA centres at primary,secondary and tertiary level health care facilities of 64 districts of Bangladesh. Screen positivecases are being referred to the colposcopy clinics of 14 government MCHs and BSMMU,where evaluation and management are carried out. From January 2005 to June 2017,1647380VIA tests were performed at different facilities with 4.6%positivity.Among the VIA+ve women attending women at the colposcopy clinic of Bangabandhu Sheikh Mujib MedicalUniversity (BSMMU), 51% had precancerous or cancerous condition of the cervix, 3312(14.10%) were treated by local excision, 2428 (10.30%)by local ablative method and1413(6%) women with cervical cancer were referred to oncology. In Bangladesh, LEEPand thermalablation has acquired acceptability as a commonly used treatment method for selected CINand ‘see-and-treat’ approach for high grade diseases combining colposcopy and LEEP/thermal ablation has been adopted since the year 2010 to improve compliance to treatment. Conclusion: Bangladesh has established VIA as screening test for prevention of cervicalcancer in quiet a good number of facilities with wide coverage. But the program has to beexpanded readily to prevent cancer and reduce sufferings & untimely death of women dueto this devastating disease. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 63-73

scholarly journals Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 144s-144s
Author(s):  
S. Mittal ◽  
P. Basu ◽  
R. Mandal ◽  
I. Ghosh ◽  
D. Banerjee ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Screening Program ◽  
Treatment Services ◽  
Primary Health ◽  
Cancer Screening Program ◽  
Follow Up Care ◽  
Cervical Cancer Screening Program

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P < 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

scholarly journals Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Oliver Chukwujekwu Ezechi ◽  
Karen Odberg Petterson ◽  
Titilola A Gabajabiamila ◽  
Ifeoma Eugenia Idigbe ◽  
Olutunmike Kuyoro ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Screening Program ◽  
Cancer Screening Program ◽  
Follow Up Care ◽  
Cervical Cancer Screening Program

Three-year follow-up of women who participated in a prison cervical cancer screening intervention

2005 ◽  
Author(s):  
Ruth Elwood Martin ◽  
Greg Hislop ◽  
Veronika Moravan ◽  
Garry Grams ◽  
Betty Calam
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening

Cervical Cancer: Assessment of Its Knowledge, Utilization of Services and Its Determinant Among Female Undergraduate Students in a Low Resource Setting

2021 ◽  
pp. 0272684X2110066
Author(s):  
Chidebe Christian Anikwe ◽  
Philip Chidubem Osuagwu ◽  
Cyril Chijioke Ikeoha ◽  
Okechukwu B Ikechukwu Dimejesi ◽  
Bartholomew Chukwunonye Okorochukwu
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Health Workers ◽  
P Value ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Resource Setting ◽  
Study Population

Background Cervical cancer is a preventable disease that contributes significantly to the death of women. This study is aimed at determining the level of knowledge and utilization of cervical cancer screening and its determinants among female undergraduates of Ebonyi State University. Methods A structured questionnaire was used for a cross-sectional survey of the study population between January 1 and March 3, 2018. The data were analyzed using IBM SPSS Statistics version 20. Data were represented with frequency table, simple percentage, mode, range, Chi square and pie chart. The level of significance is at P-value < 0.05. Results Majority (74.8%) of the respondents were aware of cervical cancer and it could be prevented (70.8%). More than three-fifths (68.30%) were informed via health workers, and 86.8% were aware that post-coital vaginal bleeding is a symptom. Less than half (49.8%) knew that HPV is the primary cause, and only 32.9% were aware of the HPV vaccine. One-quarter of the respondent were aware that early coitarche is a risk factor for cervical cancer. Only 41.8% of the women were aware of Pap smear, 9.2% had undergone screening, and 97.6% were willing to be screened. Marital status was the significant determinant of being screened while class level did not significantly influence uptake of cervical cancer screening. The most common reason (20.6%) for not being screened was lack of awareness of the test. Conclusion Our study population had a good knowledge of cervical cancer, but utilization of cervical cancer screening was poor. Awareness creation through the mass media and provision of affordable screening services can promote the use of cervical cancer screening in the study area.

scholarly journals Clinical follow-up practices after cervical cancer screening by co-testing: A population-based study of adherence to U.S. guideline recommendations

2021 ◽  
Vol 153 ◽  
pp. 106770
Author(s):  
Rebecca B. Perkins ◽  
Rachael Adcock ◽  
Vicki Benard ◽  
Jack Cuzick ◽  
Alan Waxman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Population Based ◽  
Population Based Study
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