Integrating cervical cancer screening and preventive therapy into reproductive health networks: Notes for the field

Abstract

Background: The Cervical Cancer Screening and Preventative Therapy (CCS&PT) partnership brings together Marie Stopes International, Population Services International, the International Planned Parenthood Federation, and Society for Family Health to integrate CCS&PT services into existing Reproductive Health Networks (RHNs). The partnership intends to rapidly scale up CCS&PT services through existing infrastructure in some of Africa’s most underserved communities. Since 2012, the partnership has been delivering CCS&PT services in Nigeria, Kenya, Tanzania and Uganda.

Objective: To measure the increase, between November 2012 and April 2015, in (a) cervical cancer screening services provided and (b) cryotherapy delivered to eligible clients who tested positive for pre-cancerous lesions of the cervix.

Methods: Services are provided using varied models and channels. Screening is targeted at women aged 30–49 years. Data were collected through routine management information systems, which include information on client demographics, service use, first time screening status, HIV status, and screening results.

Results: From November 2012 to April 2015, the CCS&PT partnership provided 911,501screenings and 7,234 treatments. Uptake of quarterly screenings and treatments have showed an increasing trend, though fewer treatments were delivered than anticipated. The loss to follow up has decreased steadily since the beginning of the project from 87% to 35%.

Discussion: The partnership has rapidly scaled-up screening services, but increasing preventive treatments has proven more challenging. Substantial progress has been made in creating institutional capacity, establishing protocols, developing training materials, conducting provider training and embedding CCS&PT services within our respective RHNs. This process has also produced greater awareness of CCS&PT services among clients and in their communities. Improving quality of service provision, referral linkages and referral tracking are priority areas for improvement.

Conclusion: Sustained integration of CCS&PT services has been more complex than originally anticipated, and requires adaptation and continual strengthening of systems. The lessons learnt are useful for new or expanding CCS&PT programmes in Africa and other regions.

Keywords: Cervical cancer, Reproductive health, Integration, Visual inspection with acetic acid screening, Cryotherapy