Cervical cancer screening for HIV positive women - programmatic lessons learned
J. Anderson1, E. Lu2, S. Kibwana2, M. Harris2
1Johns Hopkins University School of Medicine, Baltimore, United States, 2Jhpiego, Baltimore, United States
Issue: Invasive cervical cancer is a leading cause of cancer deaths among women in low-resource settings. HIV-infected women have higher incidence, prevalence and longer persistence of HPV infection, the primary cause of cervical cancer. In low-resource settings, Pap smear screening is generally not possible; visual inspection of the cervix with acetic acid (VIA), followed by the offer of immediate cryotherapy, is cost effective and has been shown to be a safe, feasible and acceptable alternative.
Description: With PEPFAR funding, Jhpiego is implementing VIA/Cryotherapy programs in Cote d'Ivore, Guyana, Mozambique, and South Africa. Services are provided by trained nurses and midwives at HIV Care and treatment (C&T) sites, as well as general health facilities that also see HIV positive women. The programs focus on policy development and advocacy, building local capacity, strengthening referral mechanisms, strenthening monitoring and evaluation, and developing appropriate community education messages.
Next Steps: Data is being collected to inform guidelines on appropriate screening frequency, and determine screening characteristics and treatment needs for HIV positive women compared to the general population. Though we are currently not collecting this information, data regarding antiretroviral treatment and CD4 counts correlated with VIA results are important for planning/development of appropriate screening and treatment protocols.
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- Countries have inadequate national guidelines on cervical cancer screening;
- C&T sites are generally unequipped to provide gynecological services; integration of cervical cancer screening requires testing of different models for training and implementation.
- HIV positive women may be more likely to require referral for large/suspicious lesions, with implications for referral protocols, and strengthening referral sites.
- Community messages should be carefully crafted with recognition that both cancer and HIV are stigmatizing conditions;
- Appropriate counseling of women requiring treatment is critical to reduce potential increased risk of transmitting HIV during healing.
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