Alternative cervical cancer prevention in low-resource settings: Experiences of visual inspection by acetic acid with single-visit approach in the first five provinces of Thailand.
BACKGROUND
After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single-visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low-resource settings such a high coverage is still hard to attain by the conventional Pap smear approach.


OBJECTIVE
To evaluate whether VIA/SVA can increase women's access to the prevention services in low-resource provinces of Thailand.


METHODS
A cross-sectional study was conducted by analysing electronic screening records of the provinces. A chi2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998-2005.


RESULTS
This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362,300 (66.8%) in the first year.


CONCLUSIONS
VIA/SVA has provided good screening coverage and lowered the financial burden in five low-resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low-resource areas.
Palanuwong
Buncha
B
Bungkan Hospital, Nongkai, Thailand 43140. bpalanuwong@yahoo.com
D019342:Acetic Acid; D000328:Adult; D003430:Cross-Sectional Studies; D003452:Cryosurgery / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D012424:Rural Population; D012680:Sensitivity and Specificity; D013785:Thailand; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000601:surgery
D007202:Indicators and Reagents; D019342:Acetic Acid