Kareem Khozaim1, Elkanah Orang'o2, Astrid Christoffersen-Deb3, Peter Itsura2, John Oguda4, Hellen Muliro4, Jackline Ndiema4, Grace Mwangi4, Matthew Strother5, Susan Cu-Uvin6, Barry Rosen3, Sierra Washington7. 1. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA. Electronic address: kkhozaim@iupui.edu. 2. Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya. 3. Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada. 4. Moi Teaching and Referral Hospital, Eldoret, Kenya. 5. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA. 6. Department of Obstetrics and Gynecology and Department of Medicine, Brown University School of Medicine, Providence, USA. 7. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA; Moi Teaching and Referral Hospital, Eldoret, Kenya.
Abstract
OBJECTIVE: To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya. METHODS: The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011. RESULTS: In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100000 women per year. Despite aggressive strategies, the overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/chemotherapy. CONCLUSION: The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.
OBJECTIVE: To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya. METHODS: The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011. RESULTS: In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100000 women per year. Despite aggressive strategies, the overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/chemotherapy. CONCLUSION: The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.
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