Implementation of a cervical cancer screening program linked to HIV care in a primary care clinic in Addis Ababa, Ethiopia

Background

Cervical cancer disproportionately affects communities in the developing world.  While traditional cytological screening methods rely on robust infrastructure hindering large-scale implementation, single-visit visual inspection with acetic acid (VIA) plus cryotherapy has shown promising results.  Ethiopia lacks nationwide cervical cancer screening. Cervical cancer screening is particularly important for women with HIV. The Family Health Clinic (FHC) of the Worldwide Orphans Foundation in Addis Ababa provides care for HIV patients including 1200 women.

Methods

We aimed to develop a cervical cancer screening program at FHC. We performed a baseline assessment and feasibility analysis for screening strategy selection through semi-structured interviews with patients, providers and ancillary staff, and governmental and private hospital officials.

Results

Multi-level barriers to screening include general lack of knowledge in regards to cancer screening by patients and providers alike; patients’ negative perception of implications of screening results and cost and time constraints associated with screening; the cost associated with implementing cryotherapy at FHC; and systems-level barriers to accessing cervical cancer services in governmental or private health facilities. Strategies were developed to mitigate barriers including providing didactic and practical VIA training for providers, patient education modules, screening and referral algorithms that include onsite VIA coupled with hospital referrals to address positive cases, and establishing a system of outcomes tracking and quality-assurance measures.

Conclusion

Despite a strategy that diverges from the single-visit approach, decentralized primary screening with subsequent referral to treatment centers along with targeted education and training for patients and providers can improve overall screening coverage.