Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

Abstract

ObjectivesTo report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania.MethodsThe pilot study was launched in 2012 after a community-level information campaign. Women aged 15–64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA).ResultsThe first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination.ConclusionsThe diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.

Tanzanian women´s knowledge about Cervical Cancer and HPV and their prevalence of positive VIA cervical screening results. Data from a Prevention and Awareness Campaign in Northern Tanzania, 2017 – 2019

“…The differences with low VIA positive screening results could be explained by the high density in primary health care facilities including HIV clinics in these settings [32]. This might also influence the lower VIA positivity in our study with only 2.6% of HIV infected participants, compared with the study from Mara where 8.2% were infected with HIV [38]. Furthermore, PrevACamp findings showed no significant difference between residence status and VIA-positivity.…”

“…Cervical cancer may impact HIV infected women differently than other populations. Studies show that women infected with HIV are more likely to appear with cervical cancer disease later in life [ 38 , 39 ]. Bateman et al assessed barriers to cervical cancer screening among HIV infected women in Tanzania and found that women had high misconceptions of cervical cancer screening and felt that diagnosis may lead to death, hence hindering women from seeking health care [ 39 ].…”

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

“…The cumulative VIA positivity was 9.2% (n = 4062) (Table 1). HIV infection was significantly associated with precancerous changes, with 16.8% of HIV+ women also VIA+ (523/3122) (Anderson et al, 2015; Bernstein et al, 2018; Dartell et al, 2014; Baldur-Felskov et al, 2018; Masalu et al, 2017; Chambuso et al, 2017; Kafuruki et al, 2013) (Table 2). High grade dysplastic lesions were often inferred by VIA screening results due to infrequency of pathologic confirmation.…”

“…Unfortunately, treatment failure due to loss to follow-up was a common trend across the cervical pre-cancer and cancer care continuum. Masalu et al found that 28.8% of women did not receive cryotherapy for significant VIA+ lesions (Masalu et al, 2017). A second study demonstrated that receiving immediate treatment for VIA+ lesions in a single visit resulted in significant reduction in loss to follow-up, as 82% of those who postponed cryotherapy did not return for the procedure (Anderson et al, 2015).…”

Screening for cervical cancer in Africa: A proposal of a different combination of VIA test and cervical smear in Uganda

“…The VIA test is one of the most widespread methods because it is the easiest to perform with a "screen-and-treat" approach. Some studies have reported a similar accuracy of the cervical smear and VIA test on women who are positive for HIV 19. By contrast, most of the studies have reported a high inter-operator variability, underlying the low accuracy and reproducibility of this test 14,20.…”