Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia.
<h4>Background</h4>Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries.<h4>Methods</h4>In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid...
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Public Library of Science (PLoS)
2015-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0122169 |
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| author | Groesbeck P Parham Mulindi H Mwanahamuntu Sharon Kapambwe Richard Muwonge Allen C Bateman Meridith Blevins Carla J Chibwesha Krista S Pfaendler Victor Mudenda Aaron L Shibemba Samson Chisele Gracilia Mkumba Bellington Vwalika Michael L Hicks Sten H Vermund Benjamin H Chi Jeffrey S A Stringer Rengaswamy Sankaranarayanan Vikrant V Sahasrabuddhe |
| author_facet | Groesbeck P Parham Mulindi H Mwanahamuntu Sharon Kapambwe Richard Muwonge Allen C Bateman Meridith Blevins Carla J Chibwesha Krista S Pfaendler Victor Mudenda Aaron L Shibemba Samson Chisele Gracilia Mkumba Bellington Vwalika Michael L Hicks Sten H Vermund Benjamin H Chi Jeffrey S A Stringer Rengaswamy Sankaranarayanan Vikrant V Sahasrabuddhe |
| author_sort | Groesbeck P Parham |
| collection | DOAJ |
| description | <h4>Background</h4>Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries.<h4>Methods</h4>In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts.<h4>Findings</h4>Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25-49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women.<h4>Interpretation</h4>We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps. |
| format | Article |
| id | doaj-art-5303fe80f32e4a53ac2bbcf04823d86c |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-5303fe80f32e4a53ac2bbcf04823d86c2025-08-20T02:34:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01104e012216910.1371/journal.pone.0122169Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia.Groesbeck P ParhamMulindi H MwanahamuntuSharon KapambweRichard MuwongeAllen C BatemanMeridith BlevinsCarla J ChibweshaKrista S PfaendlerVictor MudendaAaron L ShibembaSamson ChiseleGracilia MkumbaBellington VwalikaMichael L HicksSten H VermundBenjamin H ChiJeffrey S A StringerRengaswamy SankaranarayananVikrant V Sahasrabuddhe<h4>Background</h4>Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries.<h4>Methods</h4>In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts.<h4>Findings</h4>Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25-49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women.<h4>Interpretation</h4>We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants for successful expansion included leveraging HIV/AIDS program investments, and context-specific information technology applications for quality assurance and filling human resource gaps.https://doi.org/10.1371/journal.pone.0122169 |
| spellingShingle | Groesbeck P Parham Mulindi H Mwanahamuntu Sharon Kapambwe Richard Muwonge Allen C Bateman Meridith Blevins Carla J Chibwesha Krista S Pfaendler Victor Mudenda Aaron L Shibemba Samson Chisele Gracilia Mkumba Bellington Vwalika Michael L Hicks Sten H Vermund Benjamin H Chi Jeffrey S A Stringer Rengaswamy Sankaranarayanan Vikrant V Sahasrabuddhe Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. PLoS ONE |
| title | Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. |
| title_full | Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. |
| title_fullStr | Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. |
| title_full_unstemmed | Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. |
| title_short | Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia. |
| title_sort | population level scale up of cervical cancer prevention services in a low resource setting development implementation and evaluation of the cervical cancer prevention program in zambia |
| url | https://doi.org/10.1371/journal.pone.0122169 |
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