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Abstract
Background: Cervical cancer remains a major health concern in developing countries, primarily due to the presence of human papillomavirus (HPV) types 16 and 18. Visual Inspection with Acetic Acid (VIA) is a common and affordable screening method, yet its effectiveness is closely tied to the skills and competency of healthcare providers. This study aimed to assess the impact of clinical training on improving VIA screening outcomes for cervical cancer in a county in Kenya.
Methods: Seven government health facilities equipped with cryotherapy machines were selected, with two healthcare providers sampled from each. A six-day VIA training intervention was conducted, combining theoretical instruction with hands-on clinical practice using preceptors to guide trainees. Baseline data were collected using questionnaires, abstraction tools, and observational checklists, followed by pre-and post-tests to measure knowledge and skill improvement.
Results: The training program significantly improved the healthcare providers’ knowledge and VIA skills (p<0.001). The cervical pre-cancer positivity rate increased from 0.8% at baseline to 14.1% post-intervention, indicating enhanced detection abilities.
Conclusion: VIA is a viable screening method in low-resource settings when healthcare providers are adequately trained. Enhanced provider confidence and competency contribute to better screening uptake and patient outcomes, highlighting the importance of integrating clinical practice with VIA training for sustainable cervical cancer prevention.
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Copyright (c) 2024 Evah Maina, Abednego Ongeso, Nancy Maingi
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
- Allahqoli, L., Laganà, A. S., Mazidimoradi, A., Salehiniya, H., Günther, V., Chiantera, V., Goghari, S. K., Ghiasvand,M.M., Rahmani, A.,Momenimovahed, Z., & Alkatout, I. (2022). Diagnosis of cervical cancer and pre-cancerous lesions by artificial intelligence: A systematic review. Diagnostics, 12(11), 2771. https://doi.org/10.3390/diagnostics12112771
- Asgary, R., Cole, H., & Adongo, P. (2016). Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: MHealth and cervical cancer screening. BMJ Open, 9(7), 3–8. https://doi.org/10.1136/bmjopen-2019-030528
- Bhattacharyya, A. K., Nath, J. D., & Deka, H. (2015). Comparative study between Pap smear and visual inspection with acetic acid (VIA) in screening of CIN and early cervical cancer. Journal of Mid-Life Health, 6(2), 53–58. https://doi.org/10.4103/0976-7800.158942
- De Sanjose, S., & Holme, F. (2019). What is needed now for successful scale-up of screening? Papillomavirus Research, 7, 175. https://doi.org/10.1016/j.pvr.2019.04.011
- KDHS. (2014). Kenya demographic health survey report. https://hpvcentre.net/statistics/reports/KEN_FS.pdf
- Namale, G., Mayanja, Y., Kamacooko, O., Bagiire, D., Ssali, A., Seeley, J., Newton, R., & Kamali, A. (2021). Visual inspection with acetic acid (VIA) positivity among female sex workers: A cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infectious Agents and Cancer, 16(1), 31. https://hpvcentre.net/statistics/reports/KEN_FS.pdf
- Nessa, A., Anwar, B. R., & Begum, S. A. (2019). Cervical cancer screening in low-resource settings. In Preventive oncology for the Gynecologist (pp. 167–185). Springer. https://doi.org/10.1007/978-981-13-3438-2_1419
- Perkins, R. B., Legler, A., Jansen, E., Bernstein, J., Pierre-Joseph, N., Eun, T. J., Biancarelli, D. L., Schuch, T. J., Leschly, K., Fenton, A. T. H. R., Adams, W. G., Clark, J. A., Drainoni, M. L., & Hanchate, A. (2020). Improving HPV vaccination rates: A stepped-wedge randomized trial. Pediatrics, 146(1), e2092737. https://doi.org/10.1542/peds.2019-2737
- Phoolcharoen, N., Varon, M. L., Baker, E., Parra, S., Carns, J., Cherry, K., Smith, C. & Salcedo, M. P. (2022). Hands-on training courses for cervical cancer screening, diagnosis, and treatment procedures in low- and middle-income countries. JCO Global Oncology, 8, 2100214. https://doi.org/10.1200/GO.21.
- Poli, U. R., Bidinger, P. D., & Gowrishankar, S. (2015). Visual inspection with acetic acid (VIA) screening program: Seven years’ experience in early detection of cervical cancer and pre-cancers in rural South India. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 40(3), 203–207. https://doi.org/10.4103/0970-0218.158873
- Saleh, H. S., Abd El Hameid, A. A., Mowafy, H. E., & Sherif, H. E. (2017). Visual inspection of the cervix with (acetic acid or Lugol’s iodine) for cervical cancer screening. Gynecology & Obstetrics, 1, 111. https://doi.org/10.4172/2475-3173.1000111
- Sankaranarayanan, R. (2012). Cervical cancer screening in the developing world. In Cervical cancer: Contemporary management (pp. 1–14). https://doi.org/10.5005/jp/books/11500_1
- Shastri, S. S., Mittra, I., Mishra, G. A., Gupta, S., Dikshit, R., Singh, S., et al. (2014). Effect of VIA screening by primary health workers: Randomized controlled study in Mumbai, India. Journal of the National Cancer Institute, 106(dju009). https://doi.org/10.1093/jnci/dju009
- Tekalegn, Y., Aman, R., Woldeyohannes, D., Sahiledengle, B., & Degno, S. (2020). Determinants of VIA positivity among women screened for cervical precancerous lesions in public hospitals of Oromia Region, Ethiopia: Unmatched case-control study. International Journal of Women's Health, 12, 587–596. https://doi.org/10.2147/IJWH.S256821
- Veena, S. (2012). Manpower training for early cervical cancer detection. Acta Obstetricia et Gynecologica Scandinavica, 91(9), 1124–1125. https://doi.org/10.1111/j.1600-0412.2012.01449.x
- World Health Organization. (2017). Training of health staff in VIA, HPV detection test and cryotherapy: Trainees handbook (ISBN 978-92-9022-555-3). World Health Organization. http://apps.who.int/iris
- World Health Organization. (2018). WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. World Health Organization. https://iris.who.int/bitstream/handle/10665/279700/9789241550390-eng.pdf
- World Health Organization. (2019). Cervical cancer. https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/
- World Health Organization. (2019). WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. World Health Organization. https://apps.who.int/iris/handle/10665/329299
- World Health Organization. (2020). WHO technical guidance and specifications of medical devices for screening and treatment of precancerous lesions in the prevention of cervical cancer. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK195239/
References
Allahqoli, L., Laganà, A. S., Mazidimoradi, A., Salehiniya, H., Günther, V., Chiantera, V., Goghari, S. K., Ghiasvand,M.M., Rahmani, A.,Momenimovahed, Z., & Alkatout, I. (2022). Diagnosis of cervical cancer and pre-cancerous lesions by artificial intelligence: A systematic review. Diagnostics, 12(11), 2771. https://doi.org/10.3390/diagnostics12112771
Asgary, R., Cole, H., & Adongo, P. (2016). Acceptability and implementation challenges of smartphone-based training of community health nurses for visual inspection with acetic acid in Ghana: MHealth and cervical cancer screening. BMJ Open, 9(7), 3–8. https://doi.org/10.1136/bmjopen-2019-030528
Bhattacharyya, A. K., Nath, J. D., & Deka, H. (2015). Comparative study between Pap smear and visual inspection with acetic acid (VIA) in screening of CIN and early cervical cancer. Journal of Mid-Life Health, 6(2), 53–58. https://doi.org/10.4103/0976-7800.158942
De Sanjose, S., & Holme, F. (2019). What is needed now for successful scale-up of screening? Papillomavirus Research, 7, 175. https://doi.org/10.1016/j.pvr.2019.04.011
KDHS. (2014). Kenya demographic health survey report. https://hpvcentre.net/statistics/reports/KEN_FS.pdf
Namale, G., Mayanja, Y., Kamacooko, O., Bagiire, D., Ssali, A., Seeley, J., Newton, R., & Kamali, A. (2021). Visual inspection with acetic acid (VIA) positivity among female sex workers: A cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infectious Agents and Cancer, 16(1), 31. https://hpvcentre.net/statistics/reports/KEN_FS.pdf
Nessa, A., Anwar, B. R., & Begum, S. A. (2019). Cervical cancer screening in low-resource settings. In Preventive oncology for the Gynecologist (pp. 167–185). Springer. https://doi.org/10.1007/978-981-13-3438-2_1419
Perkins, R. B., Legler, A., Jansen, E., Bernstein, J., Pierre-Joseph, N., Eun, T. J., Biancarelli, D. L., Schuch, T. J., Leschly, K., Fenton, A. T. H. R., Adams, W. G., Clark, J. A., Drainoni, M. L., & Hanchate, A. (2020). Improving HPV vaccination rates: A stepped-wedge randomized trial. Pediatrics, 146(1), e2092737. https://doi.org/10.1542/peds.2019-2737
Phoolcharoen, N., Varon, M. L., Baker, E., Parra, S., Carns, J., Cherry, K., Smith, C. & Salcedo, M. P. (2022). Hands-on training courses for cervical cancer screening, diagnosis, and treatment procedures in low- and middle-income countries. JCO Global Oncology, 8, 2100214. https://doi.org/10.1200/GO.21.
Poli, U. R., Bidinger, P. D., & Gowrishankar, S. (2015). Visual inspection with acetic acid (VIA) screening program: Seven years’ experience in early detection of cervical cancer and pre-cancers in rural South India. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 40(3), 203–207. https://doi.org/10.4103/0970-0218.158873
Saleh, H. S., Abd El Hameid, A. A., Mowafy, H. E., & Sherif, H. E. (2017). Visual inspection of the cervix with (acetic acid or Lugol’s iodine) for cervical cancer screening. Gynecology & Obstetrics, 1, 111. https://doi.org/10.4172/2475-3173.1000111
Sankaranarayanan, R. (2012). Cervical cancer screening in the developing world. In Cervical cancer: Contemporary management (pp. 1–14). https://doi.org/10.5005/jp/books/11500_1
Shastri, S. S., Mittra, I., Mishra, G. A., Gupta, S., Dikshit, R., Singh, S., et al. (2014). Effect of VIA screening by primary health workers: Randomized controlled study in Mumbai, India. Journal of the National Cancer Institute, 106(dju009). https://doi.org/10.1093/jnci/dju009
Tekalegn, Y., Aman, R., Woldeyohannes, D., Sahiledengle, B., & Degno, S. (2020). Determinants of VIA positivity among women screened for cervical precancerous lesions in public hospitals of Oromia Region, Ethiopia: Unmatched case-control study. International Journal of Women's Health, 12, 587–596. https://doi.org/10.2147/IJWH.S256821
Veena, S. (2012). Manpower training for early cervical cancer detection. Acta Obstetricia et Gynecologica Scandinavica, 91(9), 1124–1125. https://doi.org/10.1111/j.1600-0412.2012.01449.x
World Health Organization. (2017). Training of health staff in VIA, HPV detection test and cryotherapy: Trainees handbook (ISBN 978-92-9022-555-3). World Health Organization. http://apps.who.int/iris
World Health Organization. (2018). WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. World Health Organization. https://iris.who.int/bitstream/handle/10665/279700/9789241550390-eng.pdf
World Health Organization. (2019). Cervical cancer. https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/
World Health Organization. (2019). WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. World Health Organization. https://apps.who.int/iris/handle/10665/329299
World Health Organization. (2020). WHO technical guidance and specifications of medical devices for screening and treatment of precancerous lesions in the prevention of cervical cancer. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK195239/