TY - JOUR
T1 - Safety, acceptability, and feasibility of a single-visit approach to cervical-cancer prevention in rural Thailand
T2 - A demonstration project
AU - Gaffikin, Lynne
AU - Blumenthal, P. D.
AU - Emerso, M.
AU - Limpaphayom, K.
AU - Lumbiganon, P.
AU - Ringers, P.
AU - Srisupundit, S.
AU - Warakamin, S.
AU - Lewis, R.
AU - Chumworathayee, Bandit
AU - Kanavacharakul, S.
N1 - Funding Information:
Roi-et Province Ministry of Public Health nurses did the fieldwork under the direct supervision of clinical supervisors from Khon Kaen University Hospital (Bundit Chumworathayee, Sanguanchoke Luanratanakorn) and Khon Kaen Provincial Hospital (Sumontha Prasertpan, Suwaree Paojirasinchai). Supervision of data collection and data entry in the field was provided by Kesara Phuttong, with assistance from Sodsuay Kanavacharakul and Rabiab Poombankhor. We thank the Roi-et Provincial Medical Directors, K Chaisiri and C Theerakanok for their assistance with this project and the district hospital directors and other facility staff who supported project implementation. Our gratitude to Khon Kaen University for providing backup clinical support and supervision and the Royal Thai College of Obstetricians and Gynaecologists for logistical and advocacy assistance. We also thank the Thai Ministry of Public Health for its support and encouragement. The village health volunteers deserve acknowledgment for their contribution to participant education and recruitment. We also thank the following JHPIEGO Corporation staff: Noel McIntosh for overall programme guidance; Sarah Slade for training and clinical input; Sapna Sharma for project coordination; Karen Mazziott for financial assistance, Saifuddin Ahmed for help with statistical analyses; Sonia Elabd for assisting with training materials and Mark Fritzler for equipment support. Finally, the team owes a debt of gratitude to the women and their families who participated in this project. This project was funded by a grant to the JHPIEGO Corporation from the Bill and Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention and by the Ministry of Public Health of Thailand.
PY - 2003/3/8
Y1 - 2003/3/8
N2 - Background: To increase screening and treatment coverage, innovative approaches to cervical-cancer prevention are being investigated in rural Thailand. We assessed the value of a single-visit approach combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. Methods: 12 trained nurses provided services in mobile (village health centre-based) and static (hospital-based) teams in four districts of Roi-et Province, Thailand. Over 7 months, 5999 women were tested by VIA. If they tested positive, after counselling about the benefits, potential risks, and probable side-effects they were offered cryotherapy. Data measuring safety, acceptability, feasibility, and effort to implement the programme were gathered. Findings: The VIA test-positive rate was 13.3% (798/5999), and 98.5% (609/618) of those eligible accepted immediate treatment. Overall, 756 women received cryotherapy, 629 (83.2%) of whom returned for their first follow-up visit. No major complications were recorded, and 33 (4.4%) of those treated returned for a perceived problem. Only 17 (2.2%) of the treated women needed clinical management other than reassurance about side-effects. Both VIA and cryotherapy were highly acceptable to the patients (over 95% expressed satisfaction with their experience). At their 1-year visit, the squamocolumnar junction was visible to the nurses, and the VIA test-negative rate was 94.3%. Interpretation A single-visit approach with VIA and cryotherapy seems to be safe, acceptable, and feasible in rural Thailand, and is a potentially efficient method of cervical-cancer prevention in such settings.
AB - Background: To increase screening and treatment coverage, innovative approaches to cervical-cancer prevention are being investigated in rural Thailand. We assessed the value of a single-visit approach combining visual inspection of the cervix with acetic acid wash (VIA) and cryotherapy. Methods: 12 trained nurses provided services in mobile (village health centre-based) and static (hospital-based) teams in four districts of Roi-et Province, Thailand. Over 7 months, 5999 women were tested by VIA. If they tested positive, after counselling about the benefits, potential risks, and probable side-effects they were offered cryotherapy. Data measuring safety, acceptability, feasibility, and effort to implement the programme were gathered. Findings: The VIA test-positive rate was 13.3% (798/5999), and 98.5% (609/618) of those eligible accepted immediate treatment. Overall, 756 women received cryotherapy, 629 (83.2%) of whom returned for their first follow-up visit. No major complications were recorded, and 33 (4.4%) of those treated returned for a perceived problem. Only 17 (2.2%) of the treated women needed clinical management other than reassurance about side-effects. Both VIA and cryotherapy were highly acceptable to the patients (over 95% expressed satisfaction with their experience). At their 1-year visit, the squamocolumnar junction was visible to the nurses, and the VIA test-negative rate was 94.3%. Interpretation A single-visit approach with VIA and cryotherapy seems to be safe, acceptable, and feasible in rural Thailand, and is a potentially efficient method of cervical-cancer prevention in such settings.
UR - http://www.scopus.com/inward/record.url?scp=0037426068&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037426068&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(03)12707-9
DO - 10.1016/S0140-6736(03)12707-9
M3 - Article
C2 - 12642047
AN - SCOPUS:0037426068
SN - 0140-6736
VL - 361
SP - 814
EP - 820
JO - Lancet
JF - Lancet
IS - 9360
ER -