Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu
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Transcript of Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu
Ricky Lu, MD, MPH
Integrating NCDs into Clinical Services Panel
CORE Group Meeting
Washington, DC
17 October, 2014
FRONTLINE CERVICAL CANCER PREVENTION
APPROACH: VIA AND CRYOTHERAPY IN ONE VISIT
CECAP Country Experience
GHANA
GUYANA
INDONESIA
MALAWI
PHILIPPINES
RWANDA
SOUTH AFRICA
THAILAND
ZIMBABWE
PERU
UGANDA
VACCINE PROJECT
*(Thailand/Philippines)
PAST PROGRAMS CURRENT PROGRAMS
BURKINA FASO
COTE D’IVOIRE
KENYA
MOZAMBIQUE
NEPAL
TANZANIA
ZAMBIA
SHORT TERM INITIATIVES ETHIOPIA
HAITI
IPPF/WHR: Guyana, Trinidad, Belize,
Suriname (May – Aug 2014)
2
Global Situation - BURDEN
Source: Bray et. Al., The Lancet Oncology 2012; 13:790-801 (DOI:10.1016/S1470-2045(12)70211-5)
Cervical Cancer
Need is Great but the Resources are Limited
20 Cervical Cancer Prevention Challenges
• An appropriate screening test is not enough to
impact cervical cancer
• Effective Service Delivery system is Essential –
The capacity to provide:
• Coverage of Eligible Population
• Appropriate management of screen positives
• Effective and Accessible Treatment at reasonable cost
• Structure for monitoring progress
Single Visit Approach (SVA) Steps
1 Counseling
2 VIA during Pelvic
Examination
3 Discuss results with the
woman and offer
cryotherapy if positive
4 Perform Cryotherapy
5 Post treatment counseling
and follow up
Service Delivery Options: SAT/SVA1
REFERRAL LEVEL
DISTRICT/PROVINCIAL
HOSPITAL
Diagnostics
Cryo and LEEP
Others
1
PHC
VIA
Cryotherapy
In SAT/SVA
3
PHC
No VIA
No Cryotherapy
2
PHC/Sub-PHC
VIA Only
4
PHC/Sub-PHC
VIA Only
SPECIALTY CENTER
Diagnostics
Cancer Management
Palliative Care
Cryo Service
Referral for addt’l care
1. Full SVA on site
2. VIA at HCF/Same day
treatment at DH/Other HCF
3. Fully Mobile SVA services
4. Partially mobile SVA
services
VIA and Cryo Service
1 Screen and Treat / Single Visit Approach
INTEGRATION
1. FP/RH
2. HCT
3. CAMPAIGNS
CECAP Results on Key Indicators: 6 Countries
Country Data time period
# of new
VIA
screenings
% (#) new
VIA positive
% of new women
referred for large
lesions
% (#) of new
women who
received
cryotherapy on
the same day as
screening (SVA)
# of people
trained
Côte d’Ivoire Oct 2009 Mar 2014 16,420 7% (1,134) 34% 71% (529) 124
Mozambique Feb 2010–Dec 2013 129,931 8% (10,182) 11% 56% (5,088) 151
Burkina Faso Sep 2010–Dec 2013 12,280 9% (1,069) 19% 67% (580) 28
Tanzania Apr 2010–Dec 2013 30,611 8% (2,384) 12% 95% (1,992) 100
Zambia Sep 2013–June 2014 1,303 3% (41) 24% 87% (27) 11
Guyana Jan 2009–Jun 2012 21,597 13% (2,806) 14% 85% (1,938) 71
Total Jan 2009–Dec 2013 211,871 8% (17,613) 11 – 34% lg lesions 79% (10,153) 485
8
Program Framework
9
SAT/SVA at the health facility level including primary health center
Strengthen referral sites
National Policies and Guidelines
Training & Supportive
Supervision; Quality
Assurance
Increased demand for screening
Monitoring and
Evaluation
Equipment, Procurement and Logistics
Thank You
It takes a minute to prevent cervical cancer-
Do the SVA !
Ricky Lu
Heather Harrison