This document summarizes the experiences of 12 countries in implementing single visit approaches (SVA) for cervical cancer prevention, which involves visual inspection with acetic acid (VIA) screening and cryotherapy treatment in a single visit. It provides data from 6 countries showing that between 3-13% of women screened through the programs tested positive for pre-cancerous lesions, and the percentage receiving same-day cryotherapy treatment ranged from 56-95%. The document advocates for strengthening referral networks and integrating cervical cancer screening with other reproductive health services at health facilities using national policies and guidelines.

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

4. Need is Great but the Resources are Limited

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