Utilization of visual inspection with acetic-acid in cervical cancer screening among health workers in secondary health care institutions of Kaduna state, Nigeria

Purpose Universal coverage of cervical cancer screening remains elusive in most low- and middle-income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy. Methods We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy. Results A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively. Conclusion This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasia was good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.

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A Population-Based Study of Visual Inspection With Acetic Acid (VIA) for Cervical Screening in Rural Nigeria

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e318280f395 ◽

2013 ◽

Vol 23 (3) ◽

pp. 507-512 ◽

Cited By ~ 20

Author(s):

Kayode Olusegun Ajenifuja ◽

Julia C. Gage ◽

Akinfolarin C. Adepiti ◽

Nicolas Wentzensen ◽

Claire Eklund ◽

...

Keyword(s):

Cervical Cancer ◽

Developing Countries ◽

Acetic Acid ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Visual Inspection ◽

Health Workers ◽

Population Based ◽

International Agency ◽

Rural Nigeria

ObjectiveCervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.MethodsIn a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.ResultsDespite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.ConclusionIn our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.

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