Simon Boni1,2, Boris Tchounga1,3, Kouassi Comoe2,4, Privat Guie5, Mesmin Adié2, Apollinaire Horo6, Eugène Messou7, Didier K Ekouévi1,8,9, François Dabis9,10, Innocent Adoubi2,4, Antoine Jaquet9. 1. Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire. 2. Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire. 3. Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon. 4. Service de cancérologie CHU de Treichville, Abidjan, Côte d'Ivoire. 5. Service de Gynécologie obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire. 6. Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Côte d'Ivoire. 7. Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire. 8. Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lomé, Togo. 9. Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France. 10. Agence Nationale de Recherche sur le VIH et Les Hépatites Virale, Paris, France.
Abstract
OBJECTIVE: To report the successes and challenges of scaling up a population-based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. METHOD: A retrospective analysis of characteristics, outcomes, and follow-up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. RESULTS: Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the "see-and-treat" approach. The 1-year follow-up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6-3.1). CONCLUSION: Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow-up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems.
OBJECTIVE: To report the successes and challenges of scaling up a population-based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. METHOD: A retrospective analysis of characteristics, outcomes, and follow-up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. RESULTS: Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the "see-and-treat" approach. The 1-year follow-up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6-3.1). CONCLUSION: Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow-up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems.
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