Development of a cervical cancer screening program in a slum setting using visual inspection with acetic acid: Analysis of feasibility and cost

Abstract

Objective: In Bangladesh, cervical cancer is the second most common cause of cancer deaths in women. Annually, over 50 million women are at risk for cervical cancer, with 17,686 cases diagnosed and 10,362 deaths each year. Visual inspection with acetic acid (VIA) is a well validated tool in low resource areas for identifying cervical lesions. In this pilot study, AK Khan Health Care Trust (AKKHCT), in collaboration with oncologists at Massachusetts General Hospital (LB, BD, AG), launched a VIA cervical cancer-screening program. Methods: A clinic was established in the Korail Slum of Dhaka, a 90-acre slum with over 70,000 inhabitants, in the summer of 2011. From September 17, 2011 to November 1, 2011, ten women living in the Korail Slum were recruited and completed the three-month training program to learn how to do a pelvic examination and to evaluate the cervix using VIA. Three of the ten women performed VIA screening during the study period. Results: 44 patients were recruited and 8 women were identified to have VIA-positive results for a screen-positive rate of 18.2%. Two of the eight women underwent treatment. One woman underwent an excisional procedure for pre-invasive disease in the slum clinic. The other woman had an early invasive cervical cancer and was successfully treated in a local hospital. Conclusion: Our pilot project demonstrates some important factors in developing and implementing a successful screening program. Involving laywomen as healthcare workers provides a strong tie to community, as well as education, economic independence, and empowerment for women who would otherwise occupy a lower social standing in their community. VIA is feasible in the complicated environment of an inner city slum. It was feasible to perform minor excisional procedures to treat pre-invasive cervical disease in the slum clinic

Prevalence and factors associated with VIA positive result among clients screened at Family Guidance Association of Ethiopia, south west area office, Jimma model clinic, Jimma, Ethiopia 2013: a cross-sectional study

“…The prevalence of VIA positive at the study clinic (12.9 %) was similar to study finding from central Ethiopia among PLWHA’s (11 %) [ 9 ] but lower than study finding from southern Ethiopia among PLWHA’s (22.1 %) [ 10 ]. It was also similar to study finding from Madagascar (11.3 %) [ 11 ], Malawi (12.4 %) [ 11 ], Latin America (12 %) [ 12 ] and Thailand (13.3 %) [ 13 ] though it is lower than study findings from Nigeria (16 %) [ 14 ], Sudan (16 %) [ 15 ] and Bangladesh (18 %) [ 16 ]. However, it is higher than study findings from Uganda (7.8 %) [ 11 ] and Tanzania (9.7 %) [ 11 ].…”

Social Impact Bonds in Bangladesh: Saving a Million Life Years and Healthcare Costs

“…There are 17,686 diagnosed cases and 10,362 deaths per year in Bangladesh [3]. For cervical cancer screening, in 2017, it was found that the crude incidence rate of cervical cancer was 12.4 per 100,000 women [4].…”

Global Health: Role of HPV Testing in Resource Poor Environment

“…In a meta-analysis of eleven African and Indian cohort and cluster randomized trials of VIA compared to colposcopy and biopsies, VIA had a sensitivity of 79% and a specificity of 85% for the detection of CIN2 or greater [10]. A strong advantage of this technique is that it can be taught to community workers [11]. VIA can be used either as a triage to more complex screening protocols of colposcopy and biopsy or in a see-and-treat protocol [12].…”