title: Cervical cancer screening using visual inspection with acetic acid: operational experiences from Ghana and Thailand.
abstract: Thailand in 2000 and Ghana in 2001 initiated cervical cancer prevention programmes using a single-visit approach with visual inspection with acetic acid (VIA) with cryotherapy for pre-cancerous lesions. This service was integrated into existing reproductive health services, provided by trained nurses. The providers maintained a high level of competence and performance, including after the withdrawal of external funding. In Ghana, independent co-assessments revealed a high level of agreement in diagnosis between providers and a Master Trainer. In Thailand, high quality performance was associated with quality assurance mechanisms such as peer feedback and review of charts and service statistics. Provider performance was maintained at a high level in both countries: an average of 74% of providers from both countries met 85% or more of performance standards. The successful transition from a demonstration project to a national programme in Thailand was dependent on a strong commitment from government health bodies and health professionals. In contrast, the lack of health infrastructure and political will has prevented scale-up to a national programme in Ghana. However, this study shows that a single-visit approach with VIA and cryotherapy is programmatically feasible and sustainable and should be considered in national investments to control cervical cancer.
authors.affiliation: Jhpiego, Baltimore MD, USA. hsanghvi@jhpiego.net
authors.forename: Harshad
authors.initials: H
authors.lastname: Sanghvi
authors.forename: Khunying Kobchitt
authors.initials: KK
authors.lastname: Limpaphayom
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.forename: Elaine
authors.initials: E
authors.lastname: Charurat
authors.forename: Amy
authors.initials: A
authors.lastname: Kleine
authors.forename: Enriquito
authors.initials: E
authors.lastname: Lu
authors.forename: Wachara
authors.initials: W
authors.lastname: Eamratsameekool
authors.forename: Buncha
authors.initials: B
authors.lastname: Palanuwong
mesh_terms: D019342:Acetic Acid; D003127:Colposcopy; D017679:Cryotherapy; D005260:Female; D005869:Ghana; D006801:Humans; D007202:Indicators and Reagents; D008403:Mass Screening / Q000379:methods*; D011322:Primary Prevention / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000379:methods; D013785:Thailand; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid