B116 Implementation of Cervical cancer screening services at 9 IHV/PEPFAR supported ART clinics in Uganda; Successes and challenges

Abstract

Background: Cervical cancer is largely preventable by effective screening programs and considerable reduction in cervical cancer incidence and deaths has been achieved in developed countries with systematic cytological smear screening programs. In September 2011, IHV Uganda in partnership with St Francis Hospital Nsambya Hospital conducted two central trainings to equip health workers with knowledge and skills in screening for cervical pre-cancerous lesions by Visual Inspection Using Acetic Acid (VIA). Facility ART coordinators were tasked to select health care workers that were currently working with the ART clinic and Post natal clinic. This assessment seeks to evaluate the success and challenges encountered following the training. Description: A standard check-list was administered to focal persons of cervical cancer screening services during routine technical assistance visits between May and June 2012 at 9 PEPFAR supported ART clinics. All Health Facilities had at least a clinician and a nurse trained in basic cervical cancer screening by Visual Inspection Using Acetic-acid. Majority of health facilities (7/9, 77.8%) were actively screening women in reproductive age for cervical precancerous lesions. 3/9 (33.3%) facilities performed screening within the MCH department and 4/9 (44.4%) within the ART clinic and 2/9 in OPD. All sites registered no stock out of Trichloroacetic acid. Women with positive results were referred to the nearest regional referral hospital for further evaluation and treatment. There was no record of follow up appointments at 8/9 (89%) health facilities. Colposcopy services were available at 1/9 sites. A total 2807 women were screened by VIA across the 9 sites, 149 (5.3%) women showed Aceto-white lesions and 9 (0.3%) showed observable cancer lesions. Lessons learned: ART clinics with Health Care workers trained in cervical cancer screening are likely to screen and refer women with pre-cancerous cervical lesions. 2) Use of a checklist is helpful in monitoring and comparing cervical cancer screening services delivered at sites. 3) Need to implement colposcopy as a point of care service. 4) Lack of space was a major barrier to provision of active cervical cancer screening. Next steps: Strengthen cervical cancer screening by implementing Point Of Care Colposcopy services, Develop standard cervical cancer screening guidelines, Broaden cervical cancer screening, linkage to care and treatment through Continuing Medical Education sessions and onsite mentorships. Build site capacity in treatment of cervical precancerous lesions.