Abstract
Background:In 2015, a See and Treat cervical cancer screening program was implemented at a local HIV clinic in Limpopo, South Africa, where infrastructure limited adequate Pap smear usability.Objectives:The purpose of this evaluation was to determine the quality and sustainability of the implemented program.Methods:A mixed-methods program analysis was conducted at 18-months post implementation. Data collection techniques included in-depth interviews of staff and patients, observation of healthcare workers delivering screening, and review of charts and patient logs.Findings:Eighteen in-depth interviews revealed improved cervical cancer screening understanding and awareness. Privacy concerns and negative perceptions of medical care were barriers to screening. Informal observations revealed continued clinical competence among healthcare workers who had been previously trained. Review of charts demonstrated positive correlation between VIA and Pap smear results. In evaluating loss to attrition, about half of the first cohort of patients were lost to follow-up. VIAs and Pap smears were offered on an ongoing basis, and month-over-month change for overlapping four months of programming between 2015 and 2016 showed a 4.4% negative change in number of Pap smears and a 57% negative change in VIAs.Conclusion:Our evaluation reveals successful integration of See and Treat into current clinic services in rural South Africa and increased awareness of cervical cancer among health workers and participants. Program sustainability was challenging to assess as many patients were lost to follow-up, given the migrant and transient population attending this clinic. Acceptance by health workers and patients alike is vital for the long-term impact on cervical cancer incidence in this region.
Highlights
Each year, 528,000 cases of cervical cancer are diagnosed worldwide, and cervical cancer accounts for 266,000 deaths [1]
Program participants were female patients who attended the HIV clinics; they were offered screening for cervical cancer using visual inspection with acetic acid (VIA) and cryotherapy if screening results were positive
Interviews Eighteen in-depth interviews were conducted with patients (12) and healthcare providers, including counselors (3), nurses (1), and peer educators known as nompilos (2)
Summary
528,000 cases of cervical cancer are diagnosed worldwide, and cervical cancer accounts for 266,000 deaths [1]. Human papilloma virus (HPV) vaccines are available to prevent cervical cancer, financial and political barriers contribute to their underutilization and inaccessibility These barriers contribute to women in lower-resource populations seeking care for this cancer late in the course of their disease when symptoms occur. In 2015, a See and Treat cervical cancer screening program was implemented at a local HIV clinic in Limpopo, South Africa, where infrastructure limited adequate Pap smear usability. VIAs and Pap smears were offered on an ongoing basis, and month-over-month change for overlapping four months of programming between 2015 and 2016 showed a 4.4% negative change in number of Pap smears and a 57% negative change in VIAs. Conclusion: Our evaluation reveals successful integration of See and Treat into current clinic services in rural South Africa and increased awareness of cervical cancer among health workers and participants. Acceptance by health workers and patients alike is vital for the long-term impact on cervical cancer incidence in this region
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