VIA is an attractive alternative to cytology-based cervix uteri screening in low-resource settings. Cryotherapy is the treatment option for test-positive individuals. Hereby a “Screen and Treat” approach can be integrated into existing reproductive health services in low-resource countries.

1. VIA
Visual Inspection with Acetic Acid of the
Cervix Uteri
Using Acetic Acid for Cervix Screening in Resource poor
Settings
Dr Dirk Grothuesmann
http://dg-maternalhealth.de/

2. Reasoning of VIA
Majority of pre-invasive and invasive Lesions of the Cervix are visible by
“Naked Eye” Examination following Acetic Acid Application
• Application of 5% Acetic Acid followed by Inspection with Halogen
Lamp
• Acetowhitening = VIA positive
• No Acteowhitening = VIA negative
White Color due to increased Protein and Nuclear Proteins and
Cytokeratin in the cervical Epithelium by CIN+
WHO, 2012

4. “Screen and Treat” Approach
• Single-visit Approach enables Clients to be screened and treated on
the same Day
• VIA and Cryotherapy Procedures are well tolerated
• “Screen and Treat” Approach can be introduced into existing
Reproductive Health Services in Low-Resource Countries
• Screening utilizing VIA, and Treatment with Cryotherapy, is acceptable
and feasible at low-level Health Facilities
• VIA is an attractive Alternative to cytology-based Screening in Low-
Resource Settings
WHO, 2014

5. Cryotherapy
• Easier to implement than other Treatment modalities such as loop
Electrosurgical Excision Procedure (LEEP), loop excision of the
Transformation Zone (LETZ) and Cone Biopsy
• Affordable Treatment
• Can be done in primary Health-Care Settings
• Feasibility Aspects have been proven in WHO Projects

6. Exclusion Criteria for VIA and Cryotherapy and
Eligibility Criteria for Cryotherapy
WHO, 2012

7. Cryotherapy

8. Cryotherapy

9. Limitations
• “See and Treat” Strategy leads to Overtreatment
• VIA less effective for elderly Patients because TZ tendency to retreat
endocervical
• VIA results are subjective to the Observer
• Although VIA is a sensitive screening Test it can not be used by itself
• Low Positive Predicative Value (PPV) of 10 – 20%
Mustafa et al, 2010

10. Advantages
• Test is inexpensive
• Can be performed with minimal Infrastructure
• Test Result are immediately available
• Training Period to acquire the Skills is short
• Can be done under flied conditions by auxiliary health Workers (when
trained accordingly)

12. Literature
Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment
with cryotherapy, WHO, 2012, from
http://apps.who.int/iris/bitstream/10665/75250/1/9789241503860_eng.pdf
Sellors JW and Sankaranarayanan R, 2003, Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A
Beginners’ Manual, International Agency for Research on Cancer, Lyon, from
http://screening.iarc.fr/doc/Colposcopymanual.pdf
WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ, WHO,
2014, from http://apps.who.int/iris/bitstream/10665/104174/1/9789241506779_eng.pdf
Visual inspection using acetic acid for cervical cancer screening in low resource settings, MJAFI, 2010, 66, 382-
384, Maj MS Mustafa, Col Ak Jingdal, Col PMP Singh, from http://medind.nic.in/maa/t10/i4/maat10i4p382.pdf

13. Annexe:
5% Acetic Acid and Lugol’s Iodine
Sellors and Sankaranarayanan , 2003

15. Aim of my Project
Dr. Dirk Grothuesmann Consultancy
Improving Maternal Health and Gynecology Services by Training Health Care
Providers: Relaying on standardized training modules I teach evidence-based
obstetrical procedures, gynecology surgery and related evaluation tools to local
personnel in developed and developing countries. Completing the programs
offered, skills gained enable to serve women in need in any requested setting.
http://dg-maternalhealth.de/index2.html

16. http://dg-maternalhealth.de/
Dr Dirk Grothuesmann
Consultancy