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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya
International Journal of Gynecology and Obstetrics, Volume 124, No. 1, Year 2014
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Description
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.
Authors & Co-Authors
Khozaim, Kareem
United States, Indianapolis
Indiana University School of Medicine
Orang'O, Elkanah Omenge
Kenya, Eldoret
Moi Teaching and Referral Hospital
Kenya, Eldoret
Moi University
Christoffersen-Deb, Astrid
Canada, Toronto
University of Toronto
Itsura, Peter Muhandale
Kenya, Eldoret
Moi Teaching and Referral Hospital
Kenya, Eldoret
Moi University
Oguda, John
Kenya, Eldoret
Moi Teaching and Referral Hospital
Muliro, Hellen
Kenya, Eldoret
Moi Teaching and Referral Hospital
Ndiema, Jackline
Kenya, Eldoret
Moi Teaching and Referral Hospital
Mwangi, Grace
Kenya, Eldoret
Moi Teaching and Referral Hospital
Strother, Robert Matthew
United States, Indianapolis
Indiana University School of Medicine
Cu-Uvin, Susan
United States, Providence
The Warren Alpert Medical School
Rosen, Barry P.
Canada, Toronto
University of Toronto
Washington, Sierra
United States, Indianapolis
Indiana University School of Medicine
Kenya, Eldoret
Moi Teaching and Referral Hospital
Statistics
Citations: 69
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1016/j.ijgo.2013.06.035
ISSN:
00207292
e-ISSN:
18793479
Research Areas
Cancer
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya
Participants Gender
Female