Delivering Cost-Effective Cervical Cancer Screening Package to Women Living With Human Immunodeficiency Virus By Reproductive Health Uganda

Abstract

Background and context: Uganda has one of the highest cervical cancer incidences in the world. Over 80% late diagnosis compounds the challenge. It is evident that women living with human immunodeficiency virus (HIV) have a higher prevalence of precancer lesions and have limited access to cervical cancer knowledge and relevant services especially women living with HIV, who are poor and marginalized. This results in a gap for first-line defense to cervical cancer. To bridge the gap and deliver services, Reproductive Health Uganda (RHU) introduced cost-effective “see and treat”, single visit approach (SVA), using combined visual inspection with acetic acid (VIA) and cryotherapy. Aim: To promote single visit approach in cervical cancer screening program in selected HIV clinics and assess the feasibility. Strategy: • Collaborate with HIV clinics, which enroll and provide counseling and services to women living with HIV • Integrate SVA into the current services package in HIV clinics and outreaches to break geographic barriers • Train RHU and public health clinic staff to perform VIA and cryotherapy if needed • Enable SVA in public antiretroviral therapy (ART) clinics through partnerships • Awareness creation through group health education and individual counseling Program: The project implemented in three high HIV prevalence rate districts targeted women 25-49 years of age. Partnered with public ART clinics and arranged training to ensure midwives and nurses in RHU and public health facilities are able to carry out VIA and cryotherapy if needed. Announcements and appointment posters were pinned up on the facility notice board providing details of dates and service package. RHU used this opportunity to promote contraception and STIs management. Health education and counseling session were conducted. Trained peer support mothers mobilized women seek cervical cancer screening when doing HIV follow-up. Quarterly support supervision, QOC assessments and DQAs were conducted to ensure quality and reliability of results and reports. Outcomes: Acceptability of cervical cancer screening was high. The project increased general awareness among rural community members, where cancer is generally stigmatized and associated with a lot of myths. Knowledge, skills and competencies of 54 midwives to screen for and treat with cryotherapy was built. 23,713 women were screened, with average VIA positivity rate 8%-11% across project districts. 98% of cryotherapy-eligible women treated during the same visit. Referral to Ugandan cancer institute was established to ensure timely cancer therapy. Integration and acceptability of family planning increased among women attending ART clinics. What was learned: With appropriate demand creation, acceptability of SVA was good among women attending the ART clinics, SVA is cost-effective and feasible. Integration of SRH package of services helps leverage resources. Strategic partnerships are critical in strengthening public–private partnership in services provision.