frontline cervical cancer prevention approach: via and cryotheraphy in one visit_lu
DESCRIPTION
CORE Global Health Practitioner Conference, Fall 2014TRANSCRIPT
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
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)
2
Global Situation - BURDEN
Source: Bray et. Al., The Lancet Oncology 2012; 13:790-801 (DOI:10.1016/S1470-2045(12)70211-5)
Cervical Cancer
Need is Great but the Resources are Limited
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
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
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
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
8
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
Thank You
It takes a minute to prevent cervical cancer-
Do the SVA !
Ricky Lu
Heather Harrison