dc.date.accessioned |
2018-02-07T07:50:39Z |
|
dc.date.available |
2018-02-07T07:50:39Z |
|
dc.date.issued |
2013-09 |
|
dc.identifier.uri |
http://ir.mu.ac.ke:8080/xmlui/handle/123456789/501 |
|
dc.description.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 |
en_US |
dc.description.sponsorship |
a Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
b Moi Teaching and Referral Hospital, Eldoret, Kenya
c Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya
d Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
e Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
f Department of Obstetrics and Gynecology and Department of Medicine, Brown University School of Medicine, Providence, USA |
en_US |
dc.publisher |
Science Direct |
en_US |
dc.relation.ispartofseries |
;International Journal of Gynecology and Obstetrics no. 124 |
|
dc.subject |
Cervical cancer, screening, Loss to follow-up, Sub-Saharan Africa, Visual inspection with acetic acid |
en_US |
dc.title |
Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya |
en_US |