Visual Inspection Using Acetic Acid Research Articles

Effect of E-Duva application on knowledge and attitude of visual inspection using acetic acid (VIA) among women of childbearing age

E-Duva is an application model designed to introduce innovations for delivering information and education about visual inspection with acetic acid (VIA) tests. The use of the E-Duva application can facilitate access to information and education for mothers without the need to visit a healthcare facility to learn about the VIA test. This study aimed to assess the effectiveness of the E-Duva application on the knowledge and attitudes of women of childbearing age (WUS). The study population comprised women of childbearing age (WUS). We employed a quasi-experimental research design with a pretest-posttest design using non-probability purposive sampling. The total sample size in this study was 30 respondents, with 15 women in the control group and 15 women in the intervention group. A questionnaire was used to assess the knowledge of WUS regarding cervical cancer and the VIA test. Statistical analysis was conducted using the Paired T-test. The study results indicate a significant increase in knowledge in both the experimental group (p = 0.000; mean SD 90.88±6.9) and the control group (p = 0.000; mean SD 78.40±10.1). Attitudes toward early detection of cervical cancer were significantly related (p = 0.015). This suggests that a more positive attitude towards early detection of cervical cancer among WUS is associated with a greater willingness to undergo cervical cancer screening. The findings of this study support the role of the E-Duva application in enhancing the knowledge and attitudes of women of childbearing age regarding VIA tests and cervical cancer, emphasizing the potential of technology-driven health education in improving women's health outcome.

Health Education of Visual Inspection Using Acetic Acid (VIA) as Cervical Cancer Screening

Cervical Cancer (CC) is the fourth most frequently diagnosed malignancy and the greatest cause of cancer death in women, with 24 out of every 100.000 women years (approximately 15/100.000) in Indonesia. Human Papilloma Virus is a cause that triggers the development of a pre/ invasive lesion 15-20 years after the initial infection. An Alternative screening technique that’s easily carried out by healthcare, such as Visual Inspection of Acetic Acid (VIA) was needed. The community service aims to address the community's ignorance and concern around VIA as CC screening, which will increase the community's (women) willingness and knowledge to assess reproductive health. Lecturers at Prima Nusantara Bukittinggi University collaborated with the Public Health Office in Bukittinggi and Mandiangian Koto Selayan District with questionnaires (20 questions as pre-test and post-test) in Forum Group Discussion in January 2021. The participants are married women. The result was the majority of participants were estimated 36-45 years old (46%), 18 participants were at university/ college educational level (36%), and the majority of the participants were housewives (50%). There was a significant difference (p-value = 0.000). Community service provides good benefits to increase the knowledge of married women. We hope the participants will want to participate in the VIA held at Prima Nusantara Bukittinggi University.

Prevalence of premalignant cervical lesions among women in community-based screening program using visual inspection with acetic acid in Metro Manila

BACKGROUND: Cervical cancer remains a health-care burden in our country. Majority of women afflicted with this cancer are diagnosed in advanced stage. Several groups like the Philippine Society for Cervical Pathology and Colposcopy (PSCPC) have put forth efforts to decrease and eventually eliminate cervical cancer through improvement in level of awareness on the disease and community-based cervical cancer screening programs using visual inspection using acetic acid (VIA). Data on the prevalence of premalignant lesions using this screening method are limited in our country. Thus, the initiative of the society (PSCPC) to embark on this study.OBJECTIVE: The objective of this study was to determine the prevalence of premalignant cervical lesions among women screened in community-based screening program using VIA in Metro Manila.METHODOLOGY: A retrospective cross-sectional study with collection of data from medical records of cervical screening programs done by the PSCPC from March 2017 to December 2019 was done. VIA was done for screening. All VIA-positive women underwent colposcopy and those with abnormal findings had colposcopically guided cervical punch biopsy.RESULTS: A total of 1072 women were screened with a positivity rate of 14.6%. One hundred and fifty-six women were VIA positive and 79 of these women underwent colposcopically guided biopsy. Premalignant cervical lesions were seen in 21 women. The prevalence rate of premalignant cervical lesions in VIA-positive women was 13.5%. The prevalence of premalignant cervical lesions among all women screened was 2%. Risk factors associated with premalignant lesions were early coitarche and smoking.CONCLUSION: The prevalence of premalignant cervical lesions among women who underwent community-based cervical cancer screening using VIA is lower compared to other studies at 2%.

Accuracy of VIA for the diagnosis of cervical cancer and associated factors among women attending cervical cancer screening at Hawassa university comprehensive specialized hospital, southern Ethiopia: Institutional based cross sectional study.

Cervical cancer is the commonest pelvic malignancy in the world, forth among women cancers, but 2nd commonest after breast cancer in the low & middle income countries. The disease is the second common in Ethiopia, with a prevalence of 13.4% with similar impact of cancer death. The aim of this study is to know the degree of cervical cancer among the suspected, & its associated factors among the women visiting the hospital for cervical cancer & precancer screening at specific period. A five years retrospective hospital based cross sectional study was conducted. All clients who came for screening with a visual inspection using acetic acid (VIA) & suspicious of cancer were included. Finally, every suspected woman with a complete chart was included. Data was coded and entered using Epi Data Version 3.1 then was exported to SPSS version 21 for analysis. Proportion, mean and standard deviation were used to describe the study variables. Then bivariate and multivariate logistic regression analyses were used to identify association between independent & outcome variables. Adjusted Odds Ratio (AOR) with 95% Confidence interval (CI) and p value (<0.05) were computed to assess the presence and degree of statistical association between dependent and independent variables. The prevalence of cervical cancer among the study women was 28%. Illiterate women suspicious with cervical cancer after positive test have five times increased odds of being diagnosed with cervical cancer than those who had formal education AOR 4.885(0.180, 0.741) 95%CI. Women with multiple sexual partners had eleven times increased odds of having cervical cancer than those with single sexual partner AOR 11.5 (1.273,24.34) 95%CI. Also, women who had referral for suspicious lesion for cervical cancer had significant association AOR 5.477(1.715-17.498) 95% CI. This study has revealed a significant proportion of cervical cancer among the participants; and the factors associated with cervical cancer were multiple sexual partners, poor educational status (Illiterate), & those referred for suspected disease.

Evaluation of Role of Visual Inspection Using Acetic Acid (VIA) and Exfoliative Cytology in Screening and Early Detection of Oral Premalignant Lesions and Oral Cancer.

Objective:Oral cancer accounts for 50–70% of total cancer mortality. VIA screening has drastically changed the morbidity and mortality related to cervical cancer. In present study, we assessed the role of 5% Acetic Acid as a vital stain in oral mucosa of chronic tobacco chewers, to know if it can help in early diagnosis and improved prognosis of oral malignancies and to assess the sensitivity and specificity of VIA and exfoliative cytology for screening of Oral premalignant and malignant lesions in high risk population with limited health care infrastructure.Methods:This was an outpatient department based prospective study done in a tertiary hospital over a period of two years. 150 cases with a history of chronic tobacco use were evaluated. Visual inspection (VI) followed by VIA using 5% Acetic acid was done. Oral scrapes were taken for cytological examination followed by biopsy for histopathological evaluation, wherever possible. Results:Sensitivity, specificity, PPV, NPV and accuracy of VIA and Exfoliative cytology was 71%, 65%, 83%, 48%, 69% and 98%, 65%, 89%, 92%, 88% respectively keeping histology as gold standard. Conclusion:Acetic acid along with exfoliative cytology can be used as simple, cost effective and convenient methods for mass screening of OPMDs and OSCC in high risk population where biopsy is not possible.

Diagnostic accuracy of cervical cancer screening and screening-triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study.

Cervical cancer screening strategies using visual inspection or cytology may have suboptimal diagnostic accuracy for detection of precancer in women living with HIV (WLHIV). The optimal screen and screen-triage strategy, age to initiate, and frequency of screening for WLHIV remain unclear. This study evaluated the sensitivity, specificity, and positive predictive value of different cervical cancer strategies in WLHIV in Africa. WLHIV aged 25-50 years attending HIV treatment centres in Burkina Faso (BF) and South Africa (SA) from 5 December 2011 to 30 October 2012 were enrolled in a prospective evaluation study of visual inspection using acetic acid (VIA) or visual inspection using Lugol's iodine (VILI), high-risk human papillomavirus DNA test (Hybrid Capture 2 [HC2] or careHPV), and cytology for histology-verified high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) at baseline and endline, a median 16 months later. Among 1,238 women (BF: 615; SA: 623), median age was 36 and 34 years (p < 0.001), 28.6% and 49.6% ever had prior cervical cancer screening (p < 0.001), and 69.9% and 64.2% were taking ART at enrolment (p = 0.045) in BF and SA, respectively. CIN2+ prevalence was 5.8% and 22.4% in BF and SA (p < 0.001), respectively. VIA had low sensitivity for CIN2+ (44.7%, 95% confidence interval [CI] 36.9%-52.7%) and CIN3+ (56.1%, 95% CI 43.3%-68.3%) in both countries, with specificity for ≤CIN1 of 78.7% (95% CI 76.0%-81.3%). HC2 had sensitivity of 88.8% (95% CI 82.9%-93.2%) for CIN2+ and 86.4% (95% CI 75.7%-93.6%) for CIN3+. Specificity for ≤CIN1 was 55.4% (95% CI 52.2%-58.6%), and screen positivity was 51.3%. Specificity was higher with a restricted genotype (HPV16/18/31/33/35/45/52/58) approach (73.5%, 95% CI 70.6%-76.2%), with lower screen positivity (33.7%), although there was lower sensitivity for CIN3+ (77.3%, 95% CI 65.3%-86.7%). In BF, HC2 was more sensitive for CIN2+/CIN3+ compared to VIA/VILI (relative sensitivity for CIN2+ = 1.72, 95% CI 1.28-2.32; CIN3+: 1.18, 95% CI 0.94-1.49). Triage of HC2-positive women with VIA/VILI reduced the number of colposcopy referrals, but with loss in sensitivity for CIN2+ (58.1%) but not for CIN3+ (84.6%). In SA, cytology high-grade squamous intraepithelial lesion or greater (HSIL+) had best combination of sensitivity (CIN2+: 70.1%, 95% CI 61.3%-77.9%; CIN3+: 80.8%, 95% CI 67.5%-90.4%) and specificity (81.6%, 95% CI 77.6%-85.1%). HC2 had similar sensitivity for CIN3+ (83.0%, 95% CI 70.2%-91.9%) but lower specificity compared to HSIL+ (42.7%, 95% CI 38.4%-47.1%; relative specificity = 0.57, 95% CI 0.52-0.63), resulting in almost twice as many referrals. Compared to HC2, triage of HC2-positive women with HSIL+ resulted in a 40% reduction in colposcopy referrals but was associated with some loss in sensitivity. CIN2+ incidence over a median 16 months was highest among VIA baseline screen-negative women (2.2%, 95% CI 1.3%-3.7%) and women who were baseline double-negative with HC2 and VIA (2.1%, 95% CI 1.3%-3.5%) and lowest among HC2 baseline screen-negative women (0.5%, 95% CI 0.1%-1.8%). Limitations of our study are that WLHIV included in the study may not reflect a contemporary cohort of WLHIV initiating ART in the universal ART era and that we did not evaluate HPV tests available in study settings today. In this cohort study among WLHIV in Africa, a human papillomavirus (HPV) test targeting 14 high-risk (HR) types had higher sensitivity to detect CIN2+ compared to visual inspection but had low specificity, although a restricted genotype approach targeting 8 HR types decreased the number of unnecessary colposcopy referrals. Cytology HSIL+ had optimal performance for CIN2+/CIN3+ detection in SA. Triage of HPV-positive women with HSIL+ maintained high specificity but with some loss in sensitivity compared to HC2 alone.

Comparison of Visual Inspection using Acetic Acid and Liquid Based Cytology for Cervical Cancer Screening in Rural Area: A Cross-Sectional Study

Introduction: Cervical cancer is the primary malignancy in Indian women. The most significant method for untimely diagnosis of cancer cervix is cytology screening, but it is not possible to launch nationwide cytology screening programme of cervical cancer. So, this has lead to the development of low cost technology e.g., visual inspection of the cervix after application of acetic acid. Aim: To compare Visual Inspection using Acetic Acid (VIA) and Liquid Based Cytology (LBC) in evaluation of abnormal cervical lesions. Materials and Methods: This was a cross-sectional study conducted on 1600 women who fulfill selection criteria. Patients attending Gynaecology Outpatient Department (OPD) with the following signs and symptoms like vaginal discharge, abnormal uterine bleeding, lowback pain, contact bleeding, and lower abdominal pain were included. After taking informed consent, the participant was subjected to detailed history, physical examination, LBC, VIA and Colposcopy followed by biopsy (if required). The sensitivity and specificity of each test are determined and compared. Data entry and analysis were done using SPSS Inc., version 11.0. Results: In present study, VIA was more sensitive (92.06%) than the LBC (68.25%) for the detection of dysplasia. However, the specificities of VIA (56.76%) and LBC (54.05%) had not much difference. Positive Pedictive Value (PPV) of VIA was 78.38% and Negative Predictive Value (NPV) of VIA was 80.77% while PPV of LBC was 71.67% and NPV of LBC was 50%. The accuracy of VIA (79%) is higher than LBC (63%). Conclusion: The VIA is more sensitive screening modality than LBC. The accuracy of VIA is higher than LBC in detecting premalignant lesion which makes it a suitable and valuable alternative screening method to cytology in poor resource setting.

Status of uterine cervical dysplasia in District Ghaziabad, U.P; India

Introduction: Cancer of cervix is a common cancer that affects Indian women physically psychologically, socially and financially. The disease affects not just the women but also her family and society. Aims and Objective: This study was designed to study status of uterine cervical dysplasia amongst women attending gynaec OPD of CHC Muradnagar, Ghaziabad, U.P. Materials and Methods: This study was done at the community health centre (CHC), Muradnagar. It was a cross-sectional study done by using VIA (visual inspection using acetic acid) technique on uterine cervix on 1250 women aged above 30 years of age attending gynaecology OPD of CHC Muradnagar, Ghaziabad U.P. Purposive sampling was used to enroll all the women who were attending the gynaecology OPD at CHC and were coming in the eligibility criteria. Result: Out of 1250 women 14 were found to be VIA positive, out of which 4 cases came out to be positive for dysplasia after doing biopsy under colposcopy. Three biopsy positive cases were found in the age group of 41 to 50 years and one case in age group of 51-60 years, two biopsy positive cases were found amongst participants who had no literacy and two were found positive amongst females who had at-least taken intermediate level or higher education, all the four biopsy positive cases were found amongst participants who were Hindu by religion, two biopsy positive cases were found amongst participants who were not working and two were found positive amongst females who were working, two biopsy positive cases were found amongst participants whose husbands were working as a professional and two cases were found positive amongst females whose husbands were working as either skilled/semi-skilled/unskilled labour or unemployed, two biopsy positive cases were found amongst participants who belonged to Class I Socio-economic status and two cases were found positive amongst females who belonged to Class III Socio-economic status. Conclusion: Our epidemiological study reveale

Factors that Affected Women Undergoing Cryotherapy Following Cancer Screening with Visual Inspection of the Cervix Using Acetic Acid Method.

Background:The Indonesian government has applied the cancer “see and treat” method which involves a visual inspection using acetic acid (VIA), followed by a cryotherapy procedure, to reduce the incidence of cervical cancer. However, compliance with the program is still low in the targeted population. This study aims to see what factors influence women to receive cryotherapy treatment if they have positive VIA result. Methods:This cross-sectional study was conducted among 356 VIA positive women, aged 30-50 years old, registered at Temanggung District Health Office, Central Java, Indonesia between March 29 and April 31, 2018. Data on whether subjects underwent cryotherapy, their demographic profile, education, knowledge about cryotherapy, and family support were collected in a direct interview using a structured questionnaire. A statistical analysis was carried out to observe the influence of all the variables on subjects’ decisions on cryotherapy. Results:In our study, 217 women (60.69%) received cryotherapy, while 139 women (39.04%) did not. Among all the variables analyzed, the factors affecting the subjects’ likelihood to undergo cryotherapy are their knowledge about cervical cancer and screening (PR=0.776;95%CI=0.660-0.913;p=0.003), their residences distance from health centre (PR=0.795;95%CI=0.650-0.971;p=0.016), permission from their family (PR=0.675;95%CI=0.556-0.820;p=0.018), and being accompanied by their family (PR=0.824;95%CI=0.700-0.970;p=0.026). Age, marital status, occupation, and education background did not show a significant correlation with the women’s decisions to receive cryotherapy. Conclusions:Interestingly, the result of our study indicates that women are less willing to undergo the cryotherapy procedure if they have good knowledge about the cryotherapy procedure and its importance in cervical cancer’s prevention. Providing higher quality and more accessible health facilities with cryotherapy services are important in influencing women’s willingness to receive cryotherapy. Family support, in the form of permission given by spouses, and if they accompanied the patient to seek cryotherapy care are observed as factors influencing women’s willingness to have the procedure.

Comparison of diagnostic accuracy of papanicoloau (PAP) Smear and visual inspection using acetic acid (VIA) in screening of cervical carcinoma, taking biopsy as gold standard.

Study Design: Cross-sectional descriptive study. Setting: Department of Obstetrics &amp; Gynecology, Bahawal Victoria Hospital, Bahawalpur. Period: 05 August 2016 to 05 Feb 2017. Material &amp; Methods: A total of 228 suspected patients of cervical carcinoma and age of 20-50 years were included. Patients with acute cervicitis, pregnant females, h/o abnormal cytology and obvious lesion on cervix were excluded. All the patients were underwent papanicoloau (PAP) smear and visual inspection using acetic acid. The results of papanicoloau (PAP) smear and visual inspection using acetic acid (VIA) were compared with cervical biopsy report. Results: In 110 papanicoloau (PAP) smear positive patients, 97 were True Positive and 13 were False Positive. Among, 118 papanicoloau (PAP) smear negative patients, 18 were False Negative whereas 100 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of papanicoloau ( PAP )smear in screening of cervical carcinoma was 84.35%, 88.50%, 88.18%, 84.75% and 86.40% respectively. In 114 visual inspection using acetic acid (VIA) positive patients, 95 were True Positive and 19 were False Positive. Among, 114 visual inspection using acetic acid (VIA) negative patients, 20 were False Negative whereas 94 were True Negative. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of visual inspection using acetic acid ( VIA) in screening of cervical carcinoma was 82.61%, 83.19%, 83.33% 82.46% and 82.89% respectively. Conclusion: This study concluded that papanicoloau ( PAP) smear and visual inspection using acetic acid (VIA) in screening of cervical carcinoma are highly sensitive, accurate and having almost equal diagnostic accuracy.

Visual Inspection Using Acetic Acid (VIA) and Pap’s Smear as Methods of Cervical Cancer Screening: An Experience of Dhaka Medical College Hospital, Dhaka, Bangladesh

Background: National screening programme for cervical cancer has been running in Bangladesh since 2004 through visual inspection using acetic acid (VIA). However, Pap’s smear is also used for the same, where it is available.Objectives: To see the effectiveness of VIA and Pap’s Smear as cervical cancer screening methods.Methods: This prospective study was done on 600 women who attended the outpatient gynaecology clinic and cervical cancer screening programme underwent both VIA and Pap’s smear cytology. Histopathology was taken as gold standard to compare the performance of VIA and cytology (Pap’s smear). Hence, positive cases were further subjected to colposcopy directed biopsy. Then the sensitivity and specificity of VIA and Pap’s smear were compared. The study was done in Dhaka Medical College Hospital, Dhaka, between July and December 2012.Results: On VIA, 46 had aceto-white lesions and on Pap’s smear, 28 had atypical squamous cells of undetermined significance (ASCUS) or worse lesions out of 600 women screened. 22 were positive on both VIA and cytology; 24 were positive on VIA only; and 6 were positive on cytology only. Histological diagnosis of CIN/carcinoma cervix was found in 36 positive cases, who underwent biopsy (n=52). Among them, 20 were picked up from Pap’s smear positive cases, whereas, 34 were VIA positive cases. VIA was found more sensitive (94.44%) than Pap’s smear (55.55%), which was statistically significant (p&lt;0.001). However, the specificity of VIA was slightly lower (97.87%) than that of cytology (98.58%). Positive predictive value (PPV) of VIA was 73.91% for VIA and 71.42% for Pap’s smear, while Negative Predictive Value (NPV) were 9.63% and 97.2% respectively.Conclusion: VIA has got much more sensitivity and slightly lower specificity than that of Pap’s smear in cervical cancer screening.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 189-193

245P - Factors influencing adherence to cryotherapy following positive VIA result as cervical cancer prevention in Temanggung, Central Java, Indonesia

BackgroundCervical cancer ranked second on women in Indonesia with 23.4/100,000 population incidence and 13.9/100,000 population mortality, emphasizing the importance of its screening and prevention. Indonesian government have applied cancer “see and treat” method with visual inspection using acetic acid (VIA) followed by cryotherapy procedure, but the number of women complying with the program were only 5% despite 80% target in 2013. This study aimed to explore factors influencing women with VIA positive result’s likelihood to receive cryotherapy. MethodsOur cross-sectional study observed “see and treat” program at Temanggung District Health Office, Central Java, Indonesia, between March 29 and April 31, 2018. We used simple random sampling technique to select 356 VIA possitive women aged 30-50 years and collected data on whether they underwent cryotherapy, their demographic profile, education, knowledge and awareness about cryotherapy, and family support using structured questionnaire. Data were analyzed with chi square analysis on STATA software. ResultsIn our study, 217 women (60.69%) received cryotherapy, while 139 women (39.04%) did not. Among all variables analysed, factors affecting subjects’ likelihood to underwent cryotherapy are knowledge about cryotherapy itself (PR = 0.776, 95%CI=0.660-0.913, p = 0.003), residence distance (PR = 0.795, 95%CI=0.650-0.971, p = 0.016), permission from family (PR = 0.675, 95%CI=0.556-0.820, p = 0.018), and accompaniment by their family (PR = 0.824, 95%CI=0.700-0.970, p = 0.026). Age, marital status, occupation, and education background did not show significant correlation with women’s decision to receive cryotherapy. ConclusionsOur study showed that more individuals with VIA positive results were willing to receive cryotherapy as an effort to prevent cervical cancer. However, our study also showed knowledge about cryotherapy, residence distance, family permission and family accompaniment as factors lowering VIA possitive women’s likelihood to receive cryotherapy. Because this study is only limited on Temanggung population, further study is needed to explore larger population and other factors that might also influence this behavior. Legal entity responsible for the studyEthics Committee, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada. FundingBoard for Development and Empowerment Human Resources of Health, Ministry of Health Republic of Indonesia. DisclosureAll authors have declared no conflicts of interest.

A study on relationship of age at first coitus and number of conceptions with the development of uterine cervical dysplasia in women undergoing VIA screening at community health centre, Muradnagar, U.P., India

Background: Cancer of cervix is a common cancer that affects Indian women physically psychologically, socially and financially. The disease affects not just the women but also her family and society. Development of cervical dysplasia is highly associated with age of first coitus and number of conception of women. This study was designed to study the correlation between age of first coitus and number of conceptions in women with development of uterine cervical dysplasia. Methods: This study was done at the Community Health Centre (CHC), Muradnagar. It was a cross-sectional study done by using VIA (visual inspection using acetic acid) technique on uterine cervix on 1250 women aged above 30 years of age attending gynaecology OPD of CHC, Muradnagar, Ghaziabad, U.P. Purposive sampling was used to enrol all the women who were attending the gynaecology OPD at CHC and were coming in the eligibility criteria. Results: Out of 1250 women 14 were found to be VIA positive, out of which 4 cases came out to be positive for dysplasia after doing biopsy under colposcopy. Conclusions: Development of cervical dysplasia is highly correlated with early age at first coitus and more number of conceptions in women. As cervical dysplasia is highly associated with early age at first coitus and more conceptions, so more screening for cervical dysplasia required in women having first coitus at early age and having more conceptions.

Thailand experiences on cervical cancer prevention using vinegar.

1517 Background: Cervicare Thailand is a visual inspection using acetic acid(VIA)and cryotherapy in a single visit approach(SVA) project that was initiated by Jhpiego,an affiliate of the Johns Hopkins University, and funded by Bill and Melinda Gates Foundation. Since 2002 the program has been supported locally. Purpose of this paper is to report of the results of scale up of the cervical cancer prevention initiative. Methods: The cervical cancer screening and treatment data were retrieved from service statistics that were routinely report in national health information system.We focused our data capture and analysis on 34 provinces where SVA is available. Additionally we utilized reports of training to supplement our data review. Results: Since 2000, there were 63 courses for SVA resulted in 1388 nurses qualified provide SVA in 34 of 77 provinces across Thailand. Another 149 clinical trainers were prepared to assist in training more providers and also conduct supportive supervision .Up to December 2013,74...

B116 Implementation of Cervical cancer screening services at 9 IHV/PEPFAR supported ART clinics in Uganda; Successes and challenges

Background: Cervical cancer is largely preventable by effective screening programs and considerable reduction in cervical cancer incidence and deaths has been achieved in developed countries with systematic cytological smear screening programs. In September 2011, IHV Uganda in partnership with St Francis Hospital Nsambya Hospital conducted two central trainings to equip health workers with knowledge and skills in screening for cervical pre-cancerous lesions by Visual Inspection Using Acetic Acid (VIA). Facility ART coordinators were tasked to select health care workers that were currently working with the ART clinic and Post natal clinic. This assessment seeks to evaluate the success and challenges encountered following the training. Description: A standard check-list was administered to focal persons of cervical cancer screening services during routine technical assistance visits between May and June 2012 at 9 PEPFAR supported ART clinics. All Health Facilities had at least a clinician and a nurse trained in basic cervical cancer screening by Visual Inspection Using Acetic-acid. Majority of health facilities (7/9, 77.8%) were actively screening women in reproductive age for cervical precancerous lesions. 3/9 (33.3%) facilities performed screening within the MCH department and 4/9 (44.4%) within the ART clinic and 2/9 in OPD. All sites registered no stock out of Trichloroacetic acid. Women with positive results were referred to the nearest regional referral hospital for further evaluation and treatment. There was no record of follow up appointments at 8/9 (89%) health facilities. Colposcopy services were available at 1/9 sites. A total 2807 women were screened by VIA across the 9 sites, 149 (5.3%) women showed Aceto-white lesions and 9 (0.3%) showed observable cancer lesions. Lessons learned: ART clinics with Health Care workers trained in cervical cancer screening are likely to screen and refer women with pre-cancerous cervical lesions. 2) Use of a checklist is helpful in monitoring and comparing cervical cancer screening services delivered at sites. 3) Need to implement colposcopy as a point of care service. 4) Lack of space was a major barrier to provision of active cervical cancer screening. Next steps: Strengthen cervical cancer screening by implementing Point Of Care Colposcopy services, Develop standard cervical cancer screening guidelines, Broaden cervical cancer screening, linkage to care and treatment through Continuing Medical Education sessions and onsite mentorships. Build site capacity in treatment of cervical precancerous lesions.

Visual inspection using acetic acid for cervical cancer in low resource settings

Cervical cancer is a major public health problem in developing countries, with India itself accounting for one-fifth of the global burden of the disease. Approximately 1,30,000 new cases of cervical cancer are being detected in the country each year. India's cervical cancer age-standardised incidence rate of 30.7 per 100,000 and age-standardised mortality rate of 17.4 per 100,000 are the highest in South Central Asia [1]. While the ultimate option for reducing the prevalence of cervical cancer is vaccination, the costs are prohibitive. Though cytology (Pap smear) is reliable, the laboratory infrastructure and logistics including technical expertise may not be available in low-resource countries. The cost factor in testing for human papillomavirus (HPV) using DNA testing, coupled with requirement of trained manpower makes this option non-viable for developing countries [2], thus accentuating the need for alternative screening procedures. Visual inspection using acetic acid (VIA) has emerged as a promising, cost effective, non-cytology based, “see and treat” alternative for economically underprivileged geographic regions [3].

Study of the Diagnostic Efficacy of Real-Time Optical Coherence Tomography as an Adjunct to Unaided Visual Inspection With Acetic Acid for the Diagnosis of Preinvasive and Invasive Neoplasia of the Uterine Cervix

To determine the sensitivity and specificity of optical coherence tomography (OCT) as an adjunct to unaided visual inspection using acetic acid (VIA) in the detection of cervical intraepithelial neoplasia 2 (CIN 2) in a real-time clinical evaluation. This clinical study was a prospective cross-sectional comparative trial that screened 1000 patients (aged 30-50 years) in a low-resource setting. Women with abnormal cervical cytology or positive human papillomavirus (HPV) tests were referred for further evaluation including VIA, OCT imaging, colposcopy, and cervical biopsies. The VIA diagnoses were coded by quadrant. The OCT was then performed in all VIA-positive areas and at the squamocolumnar junction in all 4 quadrants. All patients were colposcoped; assessed by quadrant with biopsies at 2, 4, 8, and 10 o'clock; all abnormal areas were biopsied; and endocervical curettage was performed. Data were analyzed using generalized estimating equations and logistic regression. Of the 1000 patients, 175 (17.5%) were HPV positive, 93 (9.3%) had abnormal cervical cytology greater than or equal to atypical squamous cells of undetermined significance, and 211 (21.1%) were either HPV positive or had abnormal cytology. The VIA, OCT, colposcopy, and biopsies were completed on 183 (86.7%) of 211 women. For VIA alone, the sensitivity and specificity in detecting lesions greater than or equal to CIN 2 was 43% and 96%. With the addition of OCT, the sensitivity increases to 62% with a specificity of 80%. With the addition of OCT, the sensitivity of VIA increased in all analyses for the detection of greater than or equal to CIN II, with a loss in specificity. We hope that the potential of this technology will be realized when a computer algorithm is generated to aid in image interpretation.

Visual inspection with acetic acid test qualities in a secondary setting

To evaluate the visual inspection using acetic acid (VIA) test qualities in a secondary (follow-up) setting, 1 year after cryotherapy treatment performed as part of the Safety, Acceptability and Feasibility demonstration project designed to evaluate the safety, acceptability and feasibility of VIA. An immediate offer of cryotherapy was made to those who test positive and are eligible for treatment. At 1 year after cryotherapy, 648 women received both a secondary (follow-up) VIA test by nurse-providers, and colposcopy with biopsy, if indicated, by trained physician colposcopists at a referral hospital. All pathologic specimens were sent for examination by a single pathologist. VIA nurse-providers assessed 42 of the 648 women (6.5%) referred as abnormal (i.e. they tested positive or were suspected of having cancer). Among the 42, the final colposcopic-based diagnosis was HSIL or higher in three cases (7.1%), of which two were HSIL and one was adenocarcinoma. Of the 606 VIA negative women, the colposcopic-based diagnosis was HSIL in only two cases (0.3%). The VIA test qualities in this setting were: a positive rate of 6.5%, a sensitivity of 60%, a specificity of 93.9%, a positive predictive value of 7.1%, a negative predictive value of 99.7% and an accuracy of 93.7%. These results are comparable to those of Pap smear in most settings.

Detección y seguimiento con inspección visual del cérvix para la prevención del cáncer cervicouterino en las zonas rurales de México

To compare the standard cervical cancer screening procedure--the Papanicolaou test or Pap smear--with detection through visual inspection using acetic acid (VIA), and visual inspection with acetic acid assisted by Aviscope (VIAM). The study was conducted between October 1998 and December 2000, in two Mixteca regions in Oaxaca, Mexico. A field trial design was used to randomize the two regions to either of the two inspection methods. In one region 2,240 women received VIA; in the other, 2,542 women received VIAM. Women positive to visual inspection and a subsample of women with negative results were referred for colposcopy and, if necessary, cervical biopsy. Statistical data analysis consisted of descriptive statistics and comparison of groups using chi-squared tests. Diagnostic values were obtained for VIA and VIAM, using as gold standards colposcopy and biopsy. VIAM identified a higher proportion of women with a cervical abnormality (16.3%) than VIA (3.4%), as well as normal women (58.5% vs. 53.8%).VIA identified a higher proportion of women with benign changes (41.2%) than VIAM (19.6%).VIAM had a greater sensitivity (p>0.05) but lower specificity (p<0.05) than VIA, using as gold standards colposcopy and biopsy. The two study groups were comparable for age, parity and cytological results; however, visual inspection results were different between the groups: VIAM identified more lesions confirmed by biopsy. The diagnostic utility of VIAM and VIA was lower than expected. Training of clinical personnel in visual inspection is critical to improve the effectiveness of these screening methods.

Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear

Objective: To test whether the performance of visual inspection using acetic acid (VIA) could be improved through adjunctive testing and to determine whether the combination of visual inspection of the cervix and HPV testing could prove useful for identifying those at highest risk of cervical precancer. Methods: Between October 1995 and August 1997, 2199 women willing to be screened for cervical cancer in peri-urban clinics in Harare, Zimbabwe received VIA, Pap smear and HPV as screening tests. The presence or absence of (pre)cancer was confirmed via colposcopy with biopsy as indicated for >97% of all women. Computerized simulations of sequential testing scenarios provided estimates of the joint (net) test qualities of different paired combinations of the three tests and allowed for comparisons with the individual test qualities. Results: Using HGSIL/CIN II-III as the reference threshold of disease, the net sensitivity and specificity of VIA and HPV when used sequentially were 63.6 and 81.9%, respectively, compared to 43.3 and 91%, respectively, when Pap smears were followed by HPV testing. VIA followed by the Pap smear yielded a net sensitivity of 37.5% and net specificity of 94.3%. Conclusions: For programs with limited resources but with the capacity for HPV testing, sequential testing involving the use of VIA followed by HPV could yield fewer false positives than the use of VIA alone at a cost of relatively few additional false negatives.