Abstract
BackgroundMalawi has the world’s highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country’s cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program.MethodsWe implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12.ResultsBetween July – August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community.ConclusionsOur exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.
Highlights
Malawi has the world’s highest cervical cancer incidence and mortality due to high rate of Human Immunodeficiency Virus (HIV) coupled with inadequate screening and treatment services
Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with visual inspection with acetic acid (VIA) and thermocoagulation was widely accepted
In Sub Saharan Africa (SSA) and other low-andmiddle-income countries (LMICs), high cervical cancer incidence and mortality is related to high rates of HIV [3, 4] coupled with inadequate screening and treatment services for precancerous lesions [5]
Summary
Malawi has the world’s highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country’s cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. In SSA and other low-andmiddle-income countries (LMICs), high cervical cancer incidence and mortality is related to high rates of HIV [3, 4] coupled with inadequate screening and treatment services for precancerous lesions [5]. To overcome some of these barriers, efforts have focused on single-visit screen-andtreat strategies that utilize low-technology equipment such as Visual Inspection with Acetic Acid (VIA) for screening and cryotherapy ablative treatment of VIApositive precancerous lesions [9]
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