Jhpiego, Ouagadougou, Burkina Faso.
Jhpiego, Baltimore, MD, USA.
Glob Health Sci Pract. 2018 Jun 29;6(2):288-298. doi: 10.9745/GHSP-D-17-00326. Print 2018 Jun 27.
Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns.
Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity.
Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy.
Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions.
Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
在布基纳法索，宫颈癌占女性癌症发病率的 23%，占女性癌症死亡率的 22%。这些比例分别是发达国家的 2 倍和 5 倍以上。在 2010 年之前，布基纳法索的宫颈癌预防（CECAP）服务仅限于临时筛查活动。
在 2010 年 9 月至 2014 年 8 月期间，项目实施者与卫生部和专业协会合作，实施了一项 CECAP 计划，该计划侧重于将醋酸视觉检查（VIA）与适用于 14 个设施中合格妇女的即时冷冻疗法治疗相结合。对有较大病变或疑似癌症的病变的妇女进行环电切除术（LEEP）。该计划培训了服务提供者，通过需求产生活动提高了认识，并加强了监测能力。
对项目活动、服务提供和项目经验教训的数据进行了分析。使用三个数据收集工具，即个人客户表、客户登记册和每月汇总表，跟踪 3 个关键的 CECAP 服务指标：使用 VIA 筛查的妇女人数、VIA 筛查阳性的妇女人数比例以及 VIA 筛查阳性的妇女人数比例。
在 4 年期间，该计划使用 VIA 对 13999 名妇女进行了宫颈癌筛查；8.9%的筛查呈阳性；65.9%的筛查阳性妇女在单次就诊时接受了冷冻治疗。在免费提供服务时，当天接受冷冻治疗的比例高达 82%至 93%，但当收取 10 美元的用户费用来支付耗材成本时，该比例降至 51%。2012 年 11 月将费用降低至 4 美元后，该比例再次增加到 78%。实施挑战包括难以跟踪转介患者、关键用品缺货、机器维护困难和用户费用过高。培训服务提供者独立监测服务、发现差距并采取纠正措施。
在传播了表明 CECAP 计划可接受性和可行性的结果后，布基纳法索卫生部于 2016 年将 CECAP 服务纳入其最低服务交付一揽子计划中。此类计划的基本组成部分包括对 VIA、冷冻治疗和 LEEP 的提供者培训；提供者和患者的需求生成；当地设备维护；稳定的供应库存；LEEP 的转诊系统；非禁止性费用；以及监测数据收集系统。
