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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Management of cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia: Lessons from the field
Gynecologic Oncology, Volume 110, No. 3, Year 2008
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Description
Objective: We demonstrate the feasibility of implementing a referral and management system for cryotherapy-ineligible women in a "screen-and-treat" cervical cancer prevention program targeting HIV-infected women in Zambia. Methods: We established criteria for patient referral, developed a training program for loop electrosurgical excision procedure (LEEP) providers, and adapted LEEP to a resource-constrained setting. Results: We successfully trained 15 nurses to perform visual inspection with acetic acid (VIA) followed by immediate cryotherapy. Women with positive tests but ineligible for cryotherapy were referred for further evaluation. We trained four Zambian physicians to evaluate referrals, perform punch biopsy, LEEP, and manage intra-operative and post-operative complications. From January 2006 through October 2007, a total of 8823 women (41.5% HIV seropositive) were evaluated by nurses in outlying prevention clinics; of these, 1477 (16.7%) were referred for physician evaluation based on established criteria. Of the 875 (59.2% of 1147 referred) that presented for evaluation, 748 (8.4% of total screened) underwent histologic evaluation in the form of punch biopsy or LEEP. Complications associated with LEEP included anesthesia reaction (n = 2) which spontaneously resolved, intra-operative (n = 12) and post-operative (n = 2) bleeding managed by local measures, and post-operative infection (n = 12) managed with antibiotics. Conclusion: With adaptations for a resource-constrained environment, we have demonstrated that performing LEEP is feasible and safe, with low rates of complications that can be managed locally. It is important to establish referral and management systems using LEEP-based excisional evaluation for women with cryotherapy-ineligible lesions in VIA-based "screen-and-treat" protocols nested within HIV-care programs in resource-constrained settings. © 2008 Elsevier Inc. All rights reserved.
Authors & Co-Authors
Pfaendler, Krista S.
United States, Pittsburgh
University of Pittsburgh School of Medicine
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Mwanahamuntu, Mulindi H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Zambia, Lusaka
University Teaching Hospital Lusaka
Zambia, Lusaka
University of Zambia School of Medicine
Sahasrabuddhe, Vikrant V.
United States, Nashville
Vanderbilt University School of Medicine
Mudenda, Victor C.
Zambia, Lusaka
University Teaching Hospital Lusaka
Zambia, Lusaka
University of Zambia School of Medicine
Stringer, Jeffrey S.A.
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Parham, Groesbeck Preer
United States, Birmingham
The University of Alabama at Birmingham
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Statistics
Citations: 88
Authors: 6
Affiliations: 6
Identifiers
Doi:
10.1016/j.ygyno.2008.04.031
ISSN:
00908258
e-ISSN:
10956859
Research Areas
Cancer
Health System And Policy
Infectious Diseases
Study Locations
Zambia
Participants Gender
Female