Joseph Ekong 1, C. Kakande 1, M. Mutabazi 1, H. Kakande 1, F. Castano 2,K. Uhuru 1 T. Emeetai 1, M. Kaur 1, R. Lulua 1 1

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1 Abstract no:tulbpe44. Integration of cervical cancer screening using visual inspection with Acetic acid and Cryotherapy treatment into HIV/AIDS services in rural districts of Western Uganda Joseph Ekong 1, C. Kakande 1, M. Mutabazi 1, H. Kakande 1, F. Castano 2,K. Uhuru 1 T. Emeetai 1, M. Kaur 1, R. Lulua 1 1 1STRIDES for Family Health, Management Sciences for Health, Kampala, Uganda, 2 Center for Health Services, Management Sciences for Health, Arlington, United States.

2 Worldwide, cervical cancer is ranked the second most common malignancy accounting for the majority of deaths from cancer in women [1]. Background There is, therefore, no specific program targeting them because they are taken as part of routine health care [4] Human immunodeficiency virus (HIV) infection has also tremendously increased the health burden worldwide. In 1993, Centers for Disease Control and Prevention (CDC) named cervical cancer as one of the acquired immunodeficiency syndrome (AIDS-) defining illness [2]. According to the Uganda national cancer registry record, cervical cancer is the leading cause of female malignancy (40%), closely followed by breast cancer (23%) [3]. The burden of these diseases has been overshadowed by the acute specific illnesses mainly caused by infectious elements. STRIDES a five year USAID funded project implemented by Management Sciences for Health (MSH) and partners in close collaboration with the Ugandan MOH, and the district health authorities, works with 15 districts of Uganda focusing on Reproductive Health /Family Planning /Child Survival and Nutrition. The project also 2012 targeted the integration of cervical cancer screening into HIV/AIDS and family planning services in Kamwenge and Kyenjojo rural districts of Western Uganda using visual inspection with acetic acid (VIA) and treatment with Cryotherapy.

3 Methods A training targeting Kyenjojo and Kamwenge districts was organized using strict selection criteria agreed upon by STRIDES and the two districts. A group of 17 health workers were selected from five antiretroviral therapy sites and invited to participate in training on VIA screening and treatment with Cryotherapy. Data are collected using the government owned health management information system, that is, an individual patient medical record form and a register book for the cervical cancer Three preceptors, including the Principal Nursing Officer of the host hospital, were engaged throughout the two-week training.

4 Between July 2012 and February 2013; 1088 women were screened for cervical cancer using VIA in the five Health facilities (1 Hospital,3 HC IVs and 1 HC III) in the districts of Kamwenge and Kyenjojo of which 208 were HIV positive women (Table 1). Results Among the HIV positive women, VIA was deemed positive in 13.5% (28/208) of which 53.6% (15/28) were treated with Cryotherapy and the rest; 46.4% were referred due to either suspected cancer or large lesions. The overall cure rate among HIV positive was 100%. All the VIA positive women received Cryotherapy on the same day. There was no bleeding episodes or severe adverse effects reported in women receiving cryotherapy. There still however remains a challenge of follow of these women as most times there is no transport and unavailability of trained staff

5 All the VIA positive women received Cryotherapy on the same day. There was no bleeding episodes or severe adverse effects reported in women receiving cryotherapy. There still however remains a challenge of follow of these women as most times there is no transport and unavailability of trained staff. See figure 3. Method

6 Conclusion Cervical cancer screening and treatment was successfully provided / established on a large scale for the first time ever in these rural districts. Screening and management for cervical cancer is feasible in rural districts of Uganda. There is a general lack of CECAP supplies and adequate space at many facilities. Therefore systems strengthening must accompany CECAP training. There is a lack of appropriately qualified staff for CECAP in most health units especially midwives, who are best suited for CECAP since they are already used to conducting pelvic examinations. Clinical officers can sometimes be substituted (as they were in some cases during this training) although this is not an ideal practice. There were generally poor infection prevention practices. Infection prevention support must precede the introduction of CECAP services. Scale up of these services to other facilities and districts is recommended.

7 References: [1] D. M. Parkin, F. Bray, J. Ferlay, and P. Pisani, Global cancer statistics, 2002, Ca-A Cancer Journal for Clinicians, vol. 55, no. 2, pp , [2] Centers for Disease Control and Prevention, MMWR. Recommendations and Reports-1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults, January 2011, htm. [3] Wabinga, Parkin, Wabwire, Nambooze Trends in cancer incidence in Kyadondo County, Uganda Br. J of cancer (9) [4] Uganda Ministry of health, 2001, The National Policy Guidelines and Service Standards for Reproductive Health Services, Published by The Reproductive Health Division, Community Health Department, Ministry of Health, 2001 ISBN 9966-B