title: Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya.
abstract: OBJECTIVE
  To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya.
  
  
  METHODS
  The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011.
  
  
  RESULTS
  In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100000 women per year. Despite aggressive strategies, the overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/chemotherapy.
  
  
  CONCLUSIONS
  The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA. Electronic address: kkhozaim@iupui.edu.
authors.forename: Kareem
authors.initials: K
authors.lastname: Khozaim
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Elkanah
authors.initials: E
authors.lastname: Orang'o
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Christoffersen-Deb
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Itsura
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Oguda
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Hellen
authors.initials: H
authors.lastname: Muliro
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Jackline
authors.initials: J
authors.lastname: Ndiema
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Mwangi
authors.affiliation: Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Strother
authors.affiliation: Department of Obstetrics and Gynecology and Department of Medicine, Brown University School of Medicine, Providence, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA; Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Sierra
authors.initials: S
authors.lastname: Washington
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
keywords: Cervical cancer screening; Loss to follow-up; Sub-Saharan Africa; Visual inspection with acetic acid