Improving Treatment Rates of Cervical Precancers Detected through Visual Screening in Cameroon, West Africa.

Transcription

1 Imprving Treatment Rates f Cervical Precancers Detected thrugh Visual Screening in Camern, West Africa. X. Yu a, E. Welty b, T. Welty b, B. Futuh c, K. Nulah b, S. Manga b, C. Sirri b and A. Zier c. a University f Kentucky Medical Center, Lexingtn, KY, USA b Camern Baptist Cnventin Health Services, Camern, West Africa c Gergetwn / Washingtn Hspital Center, Washingtn, DC, USA

2 Disclsures I have n financial interest t disclse

3 Backgrund

4 Where did we begin? In 2007, Wmen s Health Prgram was implemented Nw 8 statinary sites and mbile clinics And >66,000 wmen screened, with an apprximate f 12,000 yearly See and treat Visual inspectin after applicatin f acidic acid (VIA), Lugl s slutin and Digital cervicgraphy (DC), real time images f the cervix prjected nt a TV mnitr visible t bth client and prvider Crytherapy r thermal cagulatin, LEEP, Bipsy perfrmed fr suspicin f cancer and difficult t diagnse lesins

5 WHO Treatment Guideline Precancers < 75% f TZ, SCJ visible, entirely cvered by prbe, 0 signs f ICC: Same day crytherapy r thermal cagulatin Precancers >=75% f TZ, SCJ nt visible, 0 sign f ICC: Trained nurses perfrm in ffice LEEP prcedures and send excised tissue f histpathlgy Suspicius fr ICC r difficult t diagnse: Bipsies are perfrmed and sent fr histpathlgy

6 Prgram Evaluatin In 2012, nly 6% f wmen with crytherapy (cry)-eligible lesins received same-day treatment and nly 30% had received cry 12 mnths after screening at Bans Baptist Hspital (BBH). In 2013, same day treatment rates fr cry-eligible lesins imprved t 52% thrugh patient and prvider educatin, better fllw up, and having the wmen pay later fr the cst f treatment. In 2016, identify persistent barriers t receiving treatment and mdify the prgram

7 Objectives We aimed t evaluate treatment rates fr patients, wh screened psitive at BBH July-December 2015.

8 Methd Trained nurses screened wmen aged at BBH and ut reach clinics with digital cervicgraphy f the acetic acid- and Lugl s idinestained cervix and treated cervical precancers with cry r lp electrical excisin prcedure (LEEP) per Wrld Health Organizatin criteria.

9 Results Of the 1436 eligible wmen wh were screened, 92 (6.4%) screened psitive, 65 had cry-eligible lesins, 15 had LEEP-eligible lesins, and 12 had lesins suspicius fr cancer. The same day treatment rate was 78.5% fr cry-eligible lesins and 6.7% fr LEEP-eligible lesins and 100% f lesins suspicius fr cancer were bipsied. At 12 mnths, treatment rates increased t 90.8% fr cry-eligible lesins and t 53.0% fr LEEP-eligible lesins. Of the 12 bipsies f lesins suspicius fr cancer, 10 (83.3%) were cnfirmed as ICC.

10 Summary Table: Treatment f cry-eligible and LEEP-eligible lesins diagnsed by visual inspectin with acetic acid and Lugl s idine enhanced by digital cervicgraphy - Bans Baptist Hspital, Nrthwest Regin, Camern Dates 1/2011 t 12/2012 1/2013 t 9/2013 7/2015 t 12/2015 Wmen screened Cry- Eligible (6.0%) (5.0%) Treated same day 17 (6.5%) Treated by 12 m 76 (51.7%) 116 (78.9%) LEEP eligible (4.5%) 51 (78.5%) 59 (90.8%) 15 (1.1%) Treated by 6 m Interventins implemented 84 (32.1%) N/A N/A Patient- prvider educatin, better fllw up, reduced cry fees, subsidized treatment csts N/A N/A Treat and pay later, acquired thermal cagulatin machine 8 (56.3%) Mre trained nurses certified t d LEEPs, same day LEEPs

11 Interventins Identify Barriers Slutins implemented: Sensitized & educated cmmunities via mbile & cmmunity utreach clinics Prmted HIV testing amng wmen screened t determine ptimal treatment Imprved database Imprved fllw up (mainly by calling cell phnes) Acquired 2 thermal cagulatin machines, $4000 ea Certified mre prviders t perfrm LEEP

12 Discussin Thermal cagulatin machines and Crytherapy Educatin: Patient and family Onging prvider training & certificatin Fllw up Outreach Phne calls Financial Supprt Treat first and pay later Cst f crytherapy in 2011 = $60, reduced t $20-$40 in Nv 2012

13 Cnclusin Same day treatment f cry-eligible lesins has increased dramatically since Hwever, since nly 53% f LEEP-eligible lesins were treated, further investigatin f barriers t LEEP treatment is needed. WHP nurse at BBH suggests this wuld imprve if she culd perfrm same-day LEEPs, rather than waiting fr scheduled LEEP clinics, nw that she has been LEEP-certified and wrks in a facility with surgical back up.

14 Acknwledgement Thmas Welty, Edith Welty, Beatrice Futuh, Simn Manga, Claudette Chi Sirri, Kathleen Nulah, Camern Baptist Cnventin Health Services Alan Tita, University f Alabama-Birmingham Abigail Zier, Gergetwn Glbal Health Elective in Camern