frontline cervical cancer prevention approach: via and cryotheraphy in one visit_lu

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Ricky Lu, MD, MPH Integrating NCDs into Clinical Services Panel CORE Group Meeting Washington, DC 17 October, 2014 FRONTLINE CERVICAL CANCER PREVENTION APPROACH: VIA AND CRYOTHERAPY IN ONE VISIT

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CORE Global Health Practitioner Conference, Fall 2014

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Page 1: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Ricky Lu, MD, MPH

Integrating NCDs into Clinical Services Panel

CORE Group Meeting

Washington, DC

17 October, 2014

FRONTLINE CERVICAL CANCER PREVENTION

APPROACH: VIA AND CRYOTHERAPY IN ONE VISIT

Page 2: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

CECAP Country Experience

GHANA

GUYANA

INDONESIA

MALAWI

PHILIPPINES

RWANDA

SOUTH AFRICA

THAILAND

ZIMBABWE

PERU

UGANDA

VACCINE PROJECT

*(Thailand/Philippines)

PAST PROGRAMS CURRENT PROGRAMS

BURKINA FASO

COTE D’IVOIRE

KENYA

MOZAMBIQUE

NEPAL

TANZANIA

ZAMBIA

SHORT TERM INITIATIVES ETHIOPIA

HAITI

IPPF/WHR: Guyana, Trinidad, Belize,

Suriname (May – Aug 2014)

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Page 4: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Need is Great but the Resources are Limited

Page 5: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

20 Cervical Cancer Prevention Challenges

• An appropriate screening test is not enough to

impact cervical cancer

• Effective Service Delivery system is Essential –

The capacity to provide:

• Coverage of Eligible Population

• Appropriate management of screen positives

• Effective and Accessible Treatment at reasonable cost

• Structure for monitoring progress

Page 6: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Single Visit Approach (SVA) Steps

1 Counseling

2 VIA during Pelvic

Examination

3 Discuss results with the

woman and offer

cryotherapy if positive

4 Perform Cryotherapy

5 Post treatment counseling

and follow up

Page 7: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Service Delivery Options: SAT/SVA1

REFERRAL LEVEL

DISTRICT/PROVINCIAL

HOSPITAL

Diagnostics

Cryo and LEEP

Others

1

PHC

VIA

Cryotherapy

In SAT/SVA

3

PHC

No VIA

No Cryotherapy

2

PHC/Sub-PHC

VIA Only

4

PHC/Sub-PHC

VIA Only

SPECIALTY CENTER

Diagnostics

Cancer Management

Palliative Care

Cryo Service

Referral for addt’l care

1. Full SVA on site

2. VIA at HCF/Same day

treatment at DH/Other HCF

3. Fully Mobile SVA services

4. Partially mobile SVA

services

VIA and Cryo Service

1 Screen and Treat / Single Visit Approach

INTEGRATION

1. FP/RH

2. HCT

3. CAMPAIGNS

Page 8: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

CECAP Results on Key Indicators: 6 Countries

Country Data time period

# of new

VIA

screenings

% (#) new

VIA positive

% of new women

referred for large

lesions

% (#) of new

women who

received

cryotherapy on

the same day as

screening (SVA)

# of people

trained

Côte d’Ivoire Oct 2009 Mar 2014 16,420 7% (1,134) 34% 71% (529) 124

Mozambique Feb 2010–Dec 2013 129,931 8% (10,182) 11% 56% (5,088) 151

Burkina Faso Sep 2010–Dec 2013 12,280 9% (1,069) 19% 67% (580) 28

Tanzania Apr 2010–Dec 2013 30,611 8% (2,384) 12% 95% (1,992) 100

Zambia Sep 2013–June 2014 1,303 3% (41) 24% 87% (27) 11

Guyana Jan 2009–Jun 2012 21,597 13% (2,806) 14% 85% (1,938) 71

Total Jan 2009–Dec 2013 211,871 8% (17,613) 11 – 34% lg lesions 79% (10,153) 485

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Page 9: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Program Framework

9

SAT/SVA at the health facility level including primary health center

Strengthen referral sites

National Policies and Guidelines

Training & Supportive

Supervision; Quality

Assurance

Increased demand for screening

Monitoring and

Evaluation

Equipment, Procurement and Logistics

Page 10: Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu

Thank You

It takes a minute to prevent cervical cancer-

Do the SVA !

Ricky Lu

[email protected]

Heather Harrison

[email protected]