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

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.

Women's perspectives on cervical screening and treatment in developing countries: experiences with new technologies and service delivery strategies.

This review of studies conducted by partners in the Alliance for Cervical Cancer Prevention (ACCP) examines women's perspectives on, and acceptability of, new cervical cancer screening and treatment approaches, management by mid-level staff, single-visit strategies, treatment side effects, and post-treatment abstinence requirements in low-resource settings. All screening, managed by female nurses and irrespective of method or constellation of methods, appeared to be highly acceptable. Similarly, cryotherapy treatment, including cryotherapy managed by nurses immediately after screening, was well-received by women in the studies. Minor side effects, although rather prevalent, and difficulties with post-treatment abstinence, did not appear to significantly deter women from recommending the procedure to friends. Rather, a sense of relief was evident, a feeling that it was better to be treated than not treated, and better to be treated sooner rather than later. While full replication may not be possible, this does not lessen the fact that screening and treatment in developing countries, even with new technologies, immediate treatment and even using mid-level providers, can be very acceptable to women if provided in a safe, caring and preferably all-female environment.