Cervical cancer prevention in Guyana in the context of HIV and AIDS

PURPOSE: Guyana has one of the highest cervical cancer incidence and HIV prevalence rates in Latin America and the Caribbean. HIV positive women are at greater risk of developing cervical cancer, an AIDS-defining condition, compared to HIV negative women. Limited cervical cancer prevention (CECAP) services exist in Guyana, with no routine screening of HIV positive women in care and treatment (C&T). A collaborative national strategy is being implemented to integrate CECAP services for HIV positive women attending C&T sites, using visual inspection with acetic acid (VIA) and cryotherapy in a single-visit approach (SVA).

METHODS: Conducted 6 day clinical training in SVA with nurses, midwives, medical extensors, and physicians recruited from C&T sites. VIA positive cases (precancerous lesions) were offered immediate treatment with cryotherapy or LEEP. Women suspected of having cervical cancer were referred to further evaluation and management. Women self-reported HIV status.

RESULTS: Developed 13 qualified health providers in VIA/cryotherapy from 6 sites, including one mobile unit. Since the collaboration began in late 2008, the national program has screened 301 women with VIA: 23 VIA positive (7.6%) treated the same day of screening; 2 women diagnosed with cervical cancer and referred to Georgetown Public Hospital Corporation. 42 HIV positive women were screened, with 4 VIA positive (9.5%).

RECOMMENDATIONS: Training a variety of health providers in SVA has the potential to increase CECAP services to HIV positive women. When scaling up, it will be important to monitor the integration of CECAP with existing services and track CECAP indicators to help inform public policy.