Abstract:
Objective: To describe the challenges and successes of integrating a public-sector cervical screening program into
a large HIV care system in western Kenya. Methods: The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic
acid (VIA) between June 2009 and October 2011. Results: In total, 6787 women were screened: 1331 (19.6%)
were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy,
143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies,
27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100 000 women per year. Despite aggressive strategies, the overall loss to follow-up was
31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy
and hysterectomy/chemotherapy. Conclusion: The established infrastructure of an HIV treatment program was
successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and
evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network
was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.
© 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved
