title: Evaluation of a single-visit approach to cervical cancer screening and treatment in Guyana: feasibility, effectiveness and lessons learned.
abstract: OBJECTIVE
  To evaluate a cervical cancer prevention project in Guyana utilizing visual inspection with acetic acid (VIA) and immediate cryotherapy in a single-visit approach; and to identify lessons learned to inform the improvement of cervical cancer prevention programs in Guyana and other low-resource settings.
  
  
  METHODS
  Service records from January 2009 to June 2012 were analyzed for 18 cervical cancer prevention sites across Guyana. Records included women's HIV status, data on visual inspection with acetic acid screening and treatment status for women's initial and 1-year follow-up screenings, provider training and retention. A process evaluation was conducted in 2011 to identify programmatic strengths and interventions for integration, scale-up and sustainability.
  
  
  RESULTS
  During the 42-month interval, 21,597 new screenings were performed, reaching 95% of HIV(+) women enrolled in care and 17% of women aged 25-49 years in Guyana. The VIA(+) rate was 13% (n = 2806); 85% of women eligible for cryotherapy received immediate treatment. Half of VIA(+) women treated with cryotherapy or loop electrosurgical excision procedure returned for a 1-year follow-up screening (n = 1027); 95% were VIA(-) at the second screening. Non-physician providers were more likely to continue offering services than physicians. Most programmatic challenges were related to systemic rather than technical/clinical issues.
  
  
  CONCLUSIONS
  The single-visit approach-based program is feasible, effective, and when scaled up, likely to have an impact on overall incidence of cervical cancer. Services can be shifted to non-physicians for scale-up of high-quality cervical cancer prevention services nationally. To ensure sustainability and expansion, support structures should be prioritized.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Martin
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.forename: Megan
authors.initials: M
authors.lastname: Wysong
authors.forename: Maureen
authors.initials: M
authors.lastname: Reinsel
authors.forename: Deborah
authors.initials: D
authors.lastname: Estep
authors.forename: John
authors.initials: J
authors.lastname: Varallo
mesh_terms: D019342:Acetic Acid; D000328:Adult; D003452:Cryosurgery; D003695:Delivery of Health Care / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006172:Guyana; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery
chemical_list: D019342:Acetic Acid
keywords: Guyana; cervical cancer screening; service delivery; single-visit approach; visual inspection with acetic acid