Screen and Triage to Facilitate Screen and Treat by Community Health Extension Workers: Task-Sharing Strategy to Achieve Universal Cervical Cancer Screening in Nigeria

Abstract

Abstract 31 Purpose Universal access to cervical cancer screening remains elusive in most low- to middle-income countries, which shoulder the greatest burden of this preventable disease. Whereas a cytology-based screening strategy is logistically impossible, the shortage of health care workers (HCWs) and appropriate training limit the implementation of cheaper and equally effective methods, such as visual inspection after application of acetic acid (VIA); however, effective use of task shifting and sharing to involve community health extension workers (CHEWs) in HIV program delivery in low- to middle-income countries has brought innovation to bear in overcoming the HCW shortage. Hence, this study leveraged this novel strategy to pilot the provision of cervical cancer screening by CHEWs in Nigeria. The current study aimed to train and support the available health care workforce in rural communities to achieve population coverage for cervical cancer screening and reduce the cervical cancer burden in Nigeria. Methods We piloted improving the knowledge and practice skills of CHEWs/CHOs in a rural local government area of Oyo state, Nigeria, to provide community-level cervical cancer screening service. Improvement in knowledge and skills was accomplished through training, technical and infrastructural support, and participatory supervision for HCWs in the PHCs and general hospital in the local government area using the VIA method and by linking VIA-positive cases to the general hospital to screen and treat. Results Fifty-one HCWs, including physicians, nurses, and CHEWs/CHOs, were trained with five PHCs, and the general hospital was provided with materials with which to administer cervical cancer screening services. Participants’ knowledge improved from an average of 50.5% at pretraining to 88.8% immediately post-training. Of the 950 eligible women who were screened in 1 year, 848 (89.3%) were screened by CHEWs/CHOs. Of the 66 who were screened as VIA positive by CHEWs/CHOs, 58 (88.1%) agreed with the supervisory team review compared with 18 (92.3%) of 19 who were screened by nurses (κ statistics, 0.84 and 0.76, respectively). Three cases of invasive cervical cancer were diagnosed during this period, two of which were by CHEWs/CHOs. Conclusion This pilot project demonstrated that, with appropriate competency training and necessary support, CHEWs/CHOs can successfully identify cervical dysplasia. These HCWs are important resources to leverage to achieve universal coverage of cervical cancer screening services in Nigeria. We plan to expand this program to involve the seven health zones in Oyo state, Nigeria, in a hub and spoke manner to establish its wider feasibility. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.