title: The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned.
abstract: BACKGROUND
  Cervical cancer is the second most common form of cancer for women in Ethiopia. Using a single-visit approach to prevent cervical cancer, the Addis Tesfa (New Hope) project in Ethiopia tested women with HIV through visual inspection of the cervix with acetic acid wash (VIA) and, if tests results were positive, offered immediate cryotherapy of the precancerous lesion or referral for loop electrosurgical excision procedure (LEEP). The objective of this article is to review screening and treatment outcomes over nearly 4 years of project implementation and to identify lessons learned to improve cervical cancer prevention programs in Ethiopia and other resource-constrained settings.
  
  
  METHODS
  We analyzed aggregate client data from August 2010 to March 2014 to obtain the number of women with HIV who were counseled, screened, and treated, as well as the number of annual follow-up visits made, from the 14 tertiary- and secondary-level health facilities implementing the single-visit approach. A health facility assessment (HFA) was also implemented from August to December 2013 to examine the effects of the single-visit approach on client flow, staff workload, and facility infrastructure 3 years after initiating the approach.
  
  
  RESULTS
  Almost all (99%) of the 16,632 women with HIV counseled about the single-visit approach were screened with VIA during the study period; 1,656 (10%) of them tested VIA positive (VIA+) for precancerous lesions. Among those who tested VIA+ and were thus eligible for cryotherapy, 1,481 (97%) received cryotherapy treatment, but only 80 (63%) women eligible for LEEP actually received the treatment. The HFA results showed frequent staff turnover, some shortage of essential supplies, and rooms that were judged by providers to be too small for delivery of cervical cancer prevention services.
  
  
  CONCLUSIONS
  The high proportions of VIA screening and cryotherapy treatment in the Addis Tesfa project suggest high acceptance of such services by women with HIV and feasibility of implementation in secondary- and tertiary-level health facilities. However, success of cervical cancer prevention programming must address wider health system challenges to ensure sustainability and appropriate scale-up to the general population of Ethiopia and other resource-constrained settings.
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Netsanet
authors.initials: N
authors.lastname: Shiferaw
authors.affiliation: Pathfinder International, Watertown, MA. Now independent consultant.
authors.forename: Graciela
authors.initials: G
authors.lastname: Salvador-Davila
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Konjit
authors.initials: K
authors.lastname: Kassahun
authors.affiliation: Pathfinder International, Watertown, MA, and Boston University School of Public Health, Boston, MA, USA.
authors.forename: Mohamad I
authors.initials: MI
authors.lastname: Brooks
authors.affiliation: Centers for Disease Control and Prevention, Addis Ababa, Ethiopia.
authors.forename: Teklu
authors.initials: T
authors.lastname: Weldegebreal
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Yewondwossen
authors.initials: Y
authors.lastname: Tilahun
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Habtamu
authors.initials: H
authors.lastname: Zerihun
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Tariku
authors.initials: T
authors.lastname: Nigatu
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Kidest
authors.initials: K
authors.lastname: Lulu
authors.affiliation: Centers for Disease Control and Prevention, Addis Ababa, Ethiopia.
authors.forename: Ismael
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Stanford Program for International Reproductive Education and Services (SPIRES), Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
authors.affiliation: Pathfinder International, Addis Ababa, Ethiopia.
authors.forename: Mengistu
authors.initials: M
authors.lastname: Asnake
mesh_terms: D002584:Cervix Uteri; D017679:Cryotherapy; D003695:Delivery of Health Care / Q000379:methods*; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy; D006268:Health Facilities; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010808:Physical Examination; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy