Impact of introduction of a colposcopy service in a rural South African sub-district on uptake of colposcopy

A Review of Cervical Cancer in South Africa: Previous, Current and Future

“…Cross-sectional studies of VIA initially were quite reassuring and most studies demonstrated relatively high sensitivity, but low specificity and positive predictive value resulting in overtreatment. In longitudinal studies however, Denny et al [27] in a randomized controlled trial of 6555 unscreened women aged 35-65 years of age showed that the sensitivity of VIA for high-grade lesions was around 48% when women were followed up for 36 months. By contrast the sensitivity of HPV DNA testing for high-risk types (using Hybrid Capture 2) was consistently higher than either cytology or VIA and had a sensitivity of 86% for high-grade cervical cancer precursors over a 36 month follow-up period.…”

The impact of decentralising colposcopy services from tertiary-level to primary-level care in inner-city Johannesburg, South Africa: a before and after study

“…Decentralisation of colposcopy services to primary-level care has several potential benefits. First, with adequate training, tasks that had been performed by highly specialised staff can be shifted to lower health worker cadres, allowing specialists to focus on more complex cases 23. Additionally, decentralisation may alleviate patient barriers to access, by bringing services closer to them—in settings they are familiar with—and reducing their transport and other costs 13 23.…”

“…First, with adequate training, tasks that had been performed by highly specialised staff can be shifted to lower health worker cadres, allowing specialists to focus on more complex cases 23. Additionally, decentralisation may alleviate patient barriers to access, by bringing services closer to them—in settings they are familiar with—and reducing their transport and other costs 13 23. Decentralisation has long been central to the provision of HIV services in this setting through, for example, task shifting, providing antiretroviral treatment in primary care services and the dispensing of drugs from local pharmacies, rather than clinics 24…”

“…In other settings, shifting services to lower care levels was found to be cost-effective, acceptable to patients and to increase rates of attendance for colposcopy 16 25 26. In the Western Cape, South Africa, for example, colposcopy services were decentralised to a district hospital and provided by a gynaecologist 23. This raised uptake of the service and reduced time to procedure.…”

Challenges and Progress of Policies on Cervical Cancer in South Africa

“…Integration of cervical health screening into other women's health services at primary health care level, as well as motivation and training of health care providers, proved to be essential factors for the success of the cervical screening program [11,12]. Even more alarming is the fact that most of the patients with an abnormal cervical smear result, referred for colposcopy or LLETZ, are placed on very long waiting lists, some as long as 18 months, due to insufficient number of health care facilities that undertake colposcopy and excision [13]. There is no value in rendering a diagnosis for any patient if treatment for that patient is delayed or not available.…”