Cervical cancer screening using visual inspection with acetic acid: operational experiences from Ghana and Thailand

• Published in: Reproductive health matters Vol. 16; no. 32; pp. 67 - 77
• Main Authors: Sanghvi, Harshad, Limpaphayom, Khunying Kobchitt, Plotkin, Marya, Charurat, Elaine, Kleine, Amy, Lu, Enriquito, Eamratsameekool, Wachara, Palanuwong, Buncha
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-11-2008; Taylor & Francis
• Subjects: Acetic Acid; Cancer; Cancer screening; Cervical cancer; Colposcopy; Cryotherapy; Features: Cervical Cancer; Female; Females; Ghana; Health Care Services; Health Policy; Health services; Humans; Indicators and Reagents; Internal Medicine; Job performance standards; Mass Screening - methods; Nurses; Obstetrics and Gynecology; Prevention; Primary Prevention - organization & administration; Public health; Quality assurance; Quality Assurance, Health Care - methods; quality of care; Quality of service; Reproductive health; scaling up of services; Screening; Services; Tests; Thailand; Training; Training devices; training of providers; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - therapy; visual inspection using acetic acid (VIA); Womens health; Thailand; Ghana; training of providers; quality assurance; scaling up of services; visual inspection using acetic acid (VIA); Ghana; Thailand; cervical cancer; quality of care
• ISSN: 0968-8080; 1460-9576
• DOI: 10.1016/S0968-8080(08)32401-X

Abstract Thailand in 2000 and Ghana in 2001 initiated cervical cancer prevention programmes using a single-visit approach with visual inspection with acetic acid (VIA) with cryotherapy for pre-cancerous lesions. This service was integrated into existing reproductive health services, provided by trained nurses. The providers maintained a high level of competence and performance, including after the withdrawal of external funding. In Ghana, independent co-assessments revealed a high level of agreement in diagnosis between providers and a Master Trainer. In Thailand, high quality performance was associated with quality assurance mechanisms such as peer feedback and review of charts and service statistics. Provider performance was maintained at a high level in both countries: an average of 74% of providers from both countries met 85% or more of performance standards. The successful transition from a demonstration project to a national programme in Thailand was dependent on a strong commitment from government health bodies and health professionals. In contrast, the lack of health infrastructure and political will has prevented scale-up to a national programme in Ghana. However, this study shows that a single-visit approach with VIA and cryotherapy is programmatically feasible and sustainable and should be considered in national investments to control cervical cancer.