ABSTRACT
OBJECTIVE: The purpose of this study was to assess the safety and acceptability of a single-visit approach to cervical cancer prevention combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. STUDY DESIGN: The study was observational. Nine clinicians were trained in VIA and cryotherapy. Over 18 months 3665 women were VIA-tested. If positive and eligible, cryotherapy was offered immediately. Treated women were followed-up at 3 months and 1 year. RESULTS: The test-positive rate was 13.2%. Of those eligible, 70.2% and 21% received immediate or delayed treatment, respectively. No major complications were recorded, and 5.6% presented for a perceived problem post-cryotherapy. Among those treated over 90% expressed satisfaction with their experience, and 96% had an indentifiable squamo-columnar junction. Only 2.6% (6/232) were test positive, 1-year posttreatment. CONCLUSION: A single-visit approach using VIA and cryotherapy proved to be safe, acceptable, and feasible in an urban African setting.
Subject(s)
Health Services Accessibility/statistics & numerical data , Mass Screening/methods , Patient Acceptance of Health Care/statistics & numerical data , Uterine Cervical Dysplasia/prevention & control , Uterine Cervical Neoplasms/prevention & control , Acetic Acid/therapeutic use , Adult , Cohort Studies , Confidence Intervals , Cryotherapy/methods , Cultural Characteristics , Developing Countries , Feasibility Studies , Female , Ghana , Humans , Middle Aged , Office Visits , Patient Compliance , Primary Prevention/organization & administration , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/therapy , Vaginal Smears , Uterine Cervical Dysplasia/pathology , Uterine Cervical Dysplasia/therapyABSTRACT
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.
