Abstract
Like many other low- and middle-income countries, Guatemala has adopted visual inspection with acetic acid (VIA) as a low-resource alternative to the Pap smear for cervical cancer screening. Nongovernmental organizations (NGOs) introduced VIA to Guatemala in 2004, and a growing number of NGOs, working both independently and in collaboration with the Guatemalan Ministry of Health, employ VIA in cervical cancer prevention programs today. While much research describes VIA efficacy and feasibility in Latin America, little is known about NGO involvement with VIA programming or experiences with VIA outside the context of clinical trials and pilot projects in the region. To explore challenges faced by NGOs implementing VIA programs in Guatemala, we conducted semi-structured interviews with 36 NGO staff members involved with 20 VIA programs as direct service providers, program administrators, and training course instructors. Additionally, we collected data through observation at 30 NGO-sponsored cervical cancer screening campaigns, 8 cervical cancer prevention conferences, and 1 week-long NGO-sponsored VIA training course. Frequently highlighted challenges included staff turnover, concerns over training quality, a need for opportunities for continued supervision, and problems with cryotherapy referrals when immediate treatment for VIA-positive women was unavailable. Reducing staff turnover, budgeting to train replacement providers, standardizing training curricula, and offering continued supervision are key strategies to improve VIA service quality and program sustainability. Alternative training methods, such as on-the-job mentoring and course prerequisites of online learning, could help increase training time available for clinical supervision. Efforts should be made to ensure that VIA testing is coupled with immediate cryotherapy, that providers trained in VIA are also trained in cryotherapy, and that cryotherapy supplies and equipment are maintained. Where this is not possible and only VIA screening is available, referral systems must be strengthened.
Highlights
Global Health: Science and Practice 2014 | Volume 2 | Number 3 limited
Twenty-four interviewees working with 13 of 20 nongovernmental organization (NGO) reported turnover of staff trained in visual inspection with acetic acid (VIA) was a problem—either among former trainees or their own programs’ practitioners
NGO program directors reported that Ministry of Health (MOH) nurses they had trained in VIA offered the exam in their posts in reproductive health for www.ghspjournal.org
Summary
Global Health: Science and Practice 2014 | Volume 2 | Number 3 limited. These countries lack infrastructure for transporting and processing cytological samples, performing colposcopy, interpreting biopsies, and providing followup care to patients through multiple clinical visits from initial screening to treatment.[2,3] As a result, the great majority of the 266,000 deaths worldwide each year due to cervical cancer occur in LMICs.[4]The World Health Organization (WHO) and the Alliance for Cervical Cancer Prevention (ACCP) have promoted visual inspection with acetic acid (VIA) as a low-cost, safe, and effective alternative to cytological screening in resource-poor settings.[5,6] When coupled with cryotherapy, VIA allows for a single-visit approach, Challenges in VIA-based cervical cancer screening in Guatemala www.ghspjournal.orgThe great majority of the 266,000 deaths each year due to cervical cancer occur in low- and middle-income countries.One of the NGO sector’s most significant contributions to cervical cancer prevention in Guatemala has been pioneering the use of VIA–cryotherapy. Global Health: Science and Practice 2014 | Volume 2 | Number 3 limited These countries lack infrastructure for transporting and processing cytological samples, performing colposcopy, interpreting biopsies, and providing followup care to patients through multiple clinical visits from initial screening to treatment.[2,3] As a result, the great majority of the 266,000 deaths worldwide each year due to cervical cancer occur in LMICs.[4]. The great majority of the 266,000 deaths each year due to cervical cancer occur in low- and middle-income countries. Like many other low- and middle-income countries, Guatemala has adopted visual inspection with acetic acid (VIA) as a low-resource alternative to the Pap smear for cervical cancer screening. While much research describes VIA efficacy and feasibility in Latin America, little is known about NGO involvement with VIA programming or experiences with VIA outside the context of clinical trials and pilot projects in the region
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