title: Evaluation of Provider Skills in Performing Visual Inspection with Acetic Acid in the Cervical Cancer Screening Program in the Meknes-Tafilalet Region of Morocco.
abstract: BACKGROUND
  This study documented the performance of providers of visual inspection with acetic acid (VIA) at primary health centers, assessing their compliance with the VIA skills checklist and determinants of non-compliance, and exploring their perceptions of VIA training sessions.
  
  
  METHODS
  A cross- sectional study was conducted among VIA providers in the Meknes-Tafilalet region of Morocco. Structured observation of their performance was conducted through supervisory visits and multiple focus group discussions (FGDs).
  
  
  RESULTS
  Performance of all the recommended steps for effective communication was observed in a low proportion of procedures (36.4%). Midwives/nurses had higher compliance than general practitioners (GPs) (p<0.001). All recommended steps for VIA examination were performed for a high proportion of procedures (82.5%). Compliance was higher among midwives/nurses than among GPs (p<0.001) and among providers in rural areas than those in urban areas (p<0.001). For pre-VIA counselling, all recommended steps were performed for only 36.8% of procedures. For post-VIA counseling, all recommended steps were performed in a high proportion (85.5% for VIA-negative and 85.1% for VIA-positive women). Midwives/nurses had higher compliance than GPs when advising VIA-positive women (p=0.009). All infection prevention practices were followed for only 14.2% of procedures, and compliance was higher among providers in rural areas than those in urban areas (p<0.001). Most FGD participants were satisfied with the content of VIA training sessions. However, they suggested periodic refresher training and supportive supervision.
  
  
  CONCLUSIONS
  Quality assurance of a cervical cancer screening program is a key element to ensure that the providers perform VIA correctly and confidently.
authors: International Agency for Research on Cancer, Lyon, France E-mail : selmounif@fellows.iarc.fr.
authors: Farida
authors: F
authors: Selmouni
authors: Catherine
authors: C
authors: Sauvaget
authors: Ahmed
authors: A
authors: Zidouh
authors: Consuelo Alvarez
authors: CA
authors: Plaza
authors: Richard
authors: R
authors: Muwonge
authors: Karima El
authors: KE
authors: Rhazi
authors: Partha
authors: P
authors: Basu
authors: Rengaswamy
authors: R
authors: Sankaranarayanan
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage*; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009018:Morocco; D012424:Rural Population; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid