Download Integration of cervical cancer screening using visual inspection with

Abstract no:TULBPE44.
Integration of cervical cancer screening using visual
inspection with Acetic acid and Cryotherapy treatment
into HIV/AIDS services in rural districts of Western
Uganda
Joseph Ekong1, C. Kakande1, M. Mutabazi1, H. Kakande1, F. Castano2,K.
Uhuru1 T. Emeetai1, M. Kaur1, R. Lulua1
11STRIDES for Family Health, Management Sciences for Health, Kampala,
Uganda,
2Center for Health Services, Management Sciences for
Health, Arlington, United States.
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Background
•
Worldwide, cervical cancer is ranked the
second most common malignancy accounting
for the majority of deaths from cancer in
women [1].
•
Human immunodeficiency virus (HIV)
infection has also tremendously increased the
health burden worldwide.
•
In 1993, Centers for Disease Control and
Prevention (CDC) named cervical cancer as
one of the acquired immunodeficiency
syndrome (AIDS-) defining illness [2].
•
According to the Uganda national cancer
registry record, cervical cancer is the leading
cause of female malignancy (40%), closely
followed by breast cancer (23%) [3].
•
•
There is, therefore, no specific program
targeting them because they are taken
as part of routine health care [4]
•
STRIDES a five year USAID funded
project implemented by Management
Sciences for Health (MSH) and partners
in close collaboration with the Ugandan
MOH, and the district health
authorities, works with 15 districts of
Uganda focusing on Reproductive
Health /Family Planning /Child Survival
and Nutrition.
•
The project also 2012 targeted the
integration of cervical cancer screening
into HIV/AIDS and family planning
services in Kamwenge and Kyenjojo
rural districts of Western Uganda using
visual inspection with acetic acid (VIA)
and treatment with Cryotherapy.
The burden of these diseases has been
overshadowed by the acute specific
illnesses mainly caused by infectious
elements.
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Methods
• A training targeting Kyenjojo and
Kamwenge districts was organized
using strict selection criteria agreed
upon by STRIDES and the two
districts.
• A group of 17 health workers were
selected from five antiretroviral
therapy sites and invited to
participate in training on VIA
screening and treatment with
Cryotherapy.
• Data are collected using the
government owned health
management information
system, that is, an individual
patient medical record form
and a register book for the
cervical cancer
• Three preceptors, including the
Principal Nursing Officer of the host
hospital, were engaged throughout
the two-week training.
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Results
• Between July 2012 and
February 2013; 1088 women
were screened for cervical
cancer using VIA in the five
Health facilities (1 Hospital,3 HC
IVs and 1 HC III) in the districts
of Kamwenge and Kyenjojo of
which 208 were HIV positive
women (Table 1).
• Among the HIV positive women,
VIA was deemed positive in 13.5%
(28/208) of which 53.6% (15/28)
were treated with Cryotherapy and
the rest; 46.4% were referred due
to either suspected cancer or large
lesions. The overall cure rate
among HIV positive was 100%.
• All the VIA positive women
received Cryotherapy on the same
day. There was no bleeding
episodes or severe adverse effects
reported in women receiving
cryotherapy.
• There still however remains a
challenge of follow of these women
as most times there is no transport
and unavailability of trained staff
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Method
• All the VIA positive women
received Cryotherapy on the
same day.
• There was no bleeding
episodes or severe adverse
effects reported in women
receiving cryotherapy.
•
There still however remains a
challenge of follow of these
women as most times there is
no transport and
unavailability of trained staff.
See figure 3.
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
Conclusion
• Cervical cancer screening and treatment was successfully provided /
established on a large scale for the first time ever in these rural districts.
• Screening and management for cervical cancer is feasible in rural districts
of Uganda.
• There is a general lack of CECAP supplies and adequate space at many
facilities. Therefore systems strengthening must accompany CECAP
training.
• There is a lack of appropriately qualified staff for CECAP in most health
units especially midwives, who are best suited for CECAP since they are
already used to conducting pelvic examinations.
• Clinical officers can sometimes be substituted (as they were in some
cases during this training) although this is not an ideal practice.
• There were generally poor infection prevention practices. Infection
prevention support must precede the introduction of CECAP services.
• Scale up of these services to other facilities and districts is recommended.
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013
References:
• [1] D. M. Parkin, F. Bray, J. Ferlay, and P. Pisani, “Global cancer
statistics, 2002,” Ca-A Cancer Journal for Clinicians, vol. 55, no. 2, pp.
74–108, 2005.
• [2] Centers for Disease Control and Prevention, “MMWR.
Recommendations and Reports-1993 Revised classification system for
HIV infection and expanded surveillance case definition for AIDS
among adolescents and adults,” January 2011,
http://www.cdc.gov/mmwr/preview/mmwrhtml/ 00018871.htm.
• [3] Wabinga, Parkin, Wabwire, Nambooze Trends in cancer incidence
in Kyadondo County, Uganda 1960 – 1997. Br. J of cancer 2000 82(9)
1585 - 1592.
• [4] Uganda Ministry of health, 2001, The National Policy Guidelines
and Service Standards for Reproductive Health Services, Published by
The Reproductive Health Division, Community Health Department,
Ministry of Health, 2001 ISBN 9966-B97-74-7
www.ias2013.org
Kuala Lumpur, Malaysia , 30 June - 3 July 2013