Seeing is Believing: VIA and the Single-Visit- Approach to Cervical Cancer Prevention

Transcription

1 Seeing is Believing: VIA and the Single-Visit- Approach to Cervical Cancer Prevention Dr. John E. Varallo - Senior Technical Advisor Heather Harrison - Senior Program Officer Katherine Lilly - Senior Program Coordinator Global Health Mini-University 2015 Washington, DC 2 March 2015

2 Session Outline/Learning Objectives Presentation; Demonstration Stations Describe the principals of visual inspection with acetic acid (VIA) and the single-visit-approach Describe/demonstrate training techniques for VIA and cryotherapy Describe why VIA/cryotherapy is a cervical cancer prevention "best buy" Describe programmatic lessons learned

3 Magnitude of the Problem Less developed regions bear 85% of global cervical cancer burden Expected to worsen to 98% by 2030 Leading cause of cancer mortality among women in many developing countries Source: GLOBOCAN

4 WHO Guidance Note 2013

5 What Is VIA? Use bright white light to visualize cervix with unaided eye Clean cervix with dilute 3-5% acetic acid solution (white vinegar) Wait at least one minute Abnormal tissue temporarily appears white (acetowhite) Get immediate results Promotes linkage of screening with treatment Before NEGATIVE VIA POSITIVE 5

6 Why VIA? Evidence-based: supported by WHO, FIGO, ACCP, others Accuracy: comparable to or better than pap smear Low-tech, simple: little infrastructure needed Task-shifting: frontline providers Immediate results: promotes linkage of screeningtreatment 6

7 Categories for VIA NEGATIVE POSITIVE SUSPECT CANCER 7

8 What is Cryotherapy? Ablative therapy for cervical lesions Freezing accomplished through special probes using carbon dioxide or nitrous oxide gas Freezing process that destroys cervical precancerous tissue by: 1. Direct cell injury 2. Vascular stasis 8

9 Why Cryotherapy? Effective: Cure rates >90% Safe: <1% infection; no effect on future fertility Highly Acceptable Low-cost: $4-5/treatment Task-shifting: nurses Mobile: bring services to the community; no electricity require Links screening with treatment 9

10 Cervical Cancer Prevention: A WHO NCD Best Buy Cervical cancer prevention through: screening (VIA) and treatment of precancerous lesions with cryotherapy Very cost-effective Very low cost Feasible (frontline) 10

11 Single Visit Approach (SVA) Steps Obtain Education consent and Counseling Apply Pelvic Cryotip exam followed to cervix by and freeze speculum for 3 exam minutes to see cervix Defrost Apply 3-5 for % 5 minutes acetic acid to 10.Re-freeze cervix; Wait for at 3 minutes least 1 minute 11.Review 4. Inspect post-treatment cervix for acetowhite and follow-up lesions instructions 5. If VIA+, determine if cryotherapy eligible 6. Discuss results and treatment options 11

12 Competency-based Training Approach VIA & Cryotherapy Training Learning by doing Classroom Simulation Hands-on Clinical Practice Focuses on performance Knowledge, Skills and Attitude Utilizes qualified clinical trainers Proficient in the procedure Ability to effectively transfer skills Key Elements: Adult learning principles Humanistic training Role Modeling Support new provider after training 12

13 Main Components of VIA/Cryotherapy Course 13 Ongoing competency development and evaluation Classroom-based knowledge update, demonstration and skills practice Ongoing skills practice and assessment Final knowledge and skills assessment Precourse knowledge and skills assessment Clinical skills checklists Final knowledge assessment; Checklists

14 Classroom-based Course Activities Knowledge, skills, attitudes Images Demonstration, coaching Models, checklists

15 Images

16 Clinic-based Course Activities Flashcard practice Group education 1-on-1 counseling VIA Cryotherapy Post-counseling Mentoring Skills assessment

17 Guyana Haiti Indonesia IPPF/Caribbean Nepal Peru Philippines Thailand Jhpiego Country Experience: Programs and Initiatives South Africa Tanzania Uganda Zambia Zimbabwe Burkina Faso Cote d Ivoire Ethiopia Ghana Kenya Malawi Mozambique Rwanda 17

18 Programmatic Lessons Program Components and Objective 1. Strong commitment from stakeholders critical 2. Capacity building requires more than initial training 3. Integrate with other services (e.g., HIV) 4. Ensure treatment SVA and strengthen referral linkages 5. Strengthening M&E is key: Using data for decision making 6. Develop effective community sensitization 18

19 Programmatic Lessons Strong commitment from stakeholders is critical Capacity building requires more than initial training 19

20 Programmatic Lessons Integrate with other services (e.g., HIV) Guyana: 95% of HIV-infected women screened with VIA at least once over 3 years Cote D Ivoire: 72% Ensure treatment SVA and strengthen referral linkages Tanzania: 95% SVA; 96% all treated Guyana: 85% SVA; 94% all treated Referrals: Initially virtually all lost to f/u; following referral strengthening, 79% and 71% treated 20

21 Programmatic Lessons Develop effective community sensitization Strengthening M&E is key: Using data for decision making 21

22 Thank You! Let s divide into two groups for the stations: 1. VIA and Cryotherapy 2. Using Data/Program support