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Frontline Cervical Cancer Prevention Approach: Via and Cryotheraphy in One Visit_Lu
1. Ricky Lu, MD, MPH
Integrating NCDs into Clinical Services Panel
CORE Group Meeting
Washington, DC
17 October, 2014
FRONTLINE CERVICAL CANCER PREVENTION APPROACH: VIA AND CRYOTHERAPY IN ONE VISIT
2. CECAP Country Experience
GHANA
GUYANA
INDONESIA
MALAWI
PHILIPPINES
RWANDA
SOUTH AFRICA
THAILAND
ZIMBABWE
PERU
UGANDA
VACCINE PROJECT *(Thailand/Philippines)
PAST PROGRAMS
CURRENT PROGRAMS
BURKINA FASO
COTE D’IVOIRE
KENYA
MOZAMBIQUE
NEPAL
TANZANIA
ZAMBIA
SHORT TERM INITIATIVES
ETHIOPIA
HAITI
IPPF/WHR: Guyana, Trinidad, Belize, Suriname (May – Aug 2014)
2
3. Global Situation - BURDEN
Source: Bray et. Al., The Lancet Oncology 2012; 13:790-801 (DOI:10.1016/S1470-2045(12)70211-5)
Cervical Cancer
5. 20 Cervical Cancer Prevention Challenges
•An appropriate screening test is not enough to impact cervical cancer
•Effective Service Delivery system is Essential – The capacity to provide:
•Coverage of Eligible Population
•Appropriate management of screen positives
•Effective and Accessible Treatment at reasonable cost
•Structure for monitoring progress
6. Single Visit Approach (SVA) Steps
1 Counseling
2 VIA during Pelvic Examination
3 Discuss results with the woman and offer cryotherapy if positive
4 Perform Cryotherapy
5 Post treatment counseling and follow up
7. Service Delivery Options: SAT/SVA1
REFERRAL LEVEL DISTRICT/PROVINCIAL HOSPITAL
Diagnostics
Cryo and LEEP
Others
1 PHC VIA Cryotherapy In SAT/SVA
3
PHC
No VIA
No Cryotherapy
2
PHC/Sub-PHC
VIA Only
4
PHC/Sub-PHC
VIA Only
SPECIALTY CENTER
Diagnostics
Cancer Management
Palliative Care
Cryo Service
Referral for addt’l care
1.Full SVA on site
2.VIA at HCF/Same day treatment at DH/Other HCF
3.Fully Mobile SVA services
4.Partially mobile SVA services
VIA and Cryo Service
1 Screen and Treat / Single Visit Approach
INTEGRATION
1.FP/RH
2.HCT
3.CAMPAIGNS
8. CECAP Results on Key Indicators: 6 Countries
Country
Data time period
# of new VIA screenings
% (#) new VIA positive
% of new women referred for large lesions
% (#) of new women who received cryotherapy on the same day as screening (SVA)
# of people trained
Côte d’Ivoire
Oct 2009 Mar 2014
16,420
7% (1,134)
34%
71% (529)
124
Mozambique
Feb 2010–Dec 2013
129,931
8% (10,182)
11%
56% (5,088)
151
Burkina Faso
Sep 2010–Dec 2013
12,280
9% (1,069)
19%
67% (580)
28
Tanzania
Apr 2010–Dec 2013
30,611
8% (2,384)
12%
95% (1,992)
100
Zambia
Sep 2013–June 2014
1,303
3% (41)
24%
87% (27)
11
Guyana
Jan 2009–Jun 2012
21,597
13% (2,806)
14%
85% (1,938)
71
Total
Jan 2009–Dec 2013
211,871
8% (17,613)
11 – 34% lg lesions
79% (10,153)
485
8
9. Program Framework
9
SAT/SVA at the health facility level including primary health center
Strengthen referral sites
National Policies and Guidelines
Training & Supportive Supervision; Quality Assurance
Increased demand for screening
Monitoring and Evaluation
Equipment, Procurement and Logistics
10. Thank You
It takes a minute to prevent cervical cancer- Do the SVA !
Ricky Lu
ricky.lu@jhpiego.org
Heather Harrison
heather.harrison@jhpiego.org