Tunis Med. 2021 Jan;99(1):158-167.
Colorectal cancer (CRC) is a real public health issue in Tunisia. A screening program based on fecal immunological occult blood test, followed in case of a positive test by colonoscopy, was launched in Tunis region in 2016. We aimed to evaluate this screening program in order to make recommendations for a better implementation of this program in years to come.
A mixed approach has been adopted with a quantitative component based on the production of indicators related to activity, monitoring and screening quality; and a qualitative component conducted through focus groups with frontline health care professionals (HCP) and individual interviews with those lost to follow-up after a positive screening test. SWOT analysis was then performed in order to assess main strengths, weaknesses, opportunities and threats of the program.
This study showed a coverage rate of 41.2% [40.5-41.8] for population consulting the first line of care, and an effective participation rate estimated at 23.1% [22.6-23.6]. Out of 5856 tests performed, 6% (n=352) were non-treatable and 6.7 % (n=390) were positive. Only 18.6% (n=72) of those tested positive had undergone colonoscopy. A total of 26 polyps, 03 cases of cancer and 04 cases of dysplasia were recorded. SWOT analysis pointed out that the variable adherence of HCP, lack of awareness of general population regarding CRC screening, the non-acceptability of colonoscopy without sedation with a problem of affordability for its realization in the private sector, and long appointments delays in public sector, were main weaknesses and of this program.
This evaluation underlined certain strengths regarding the program implementation and revealed, in return, several shortcomings which certainly impair the program's effectiveness and efficiency. The involvement of the national health insurance fund in CRC screening tests and colonoscopies reimbursement, as well as the establishment of a performance-based payment modality for HCP, constitute main key pillars to reach success and sustainability for any CCR mass screening program in Tunisia.
结直肠癌（CRC）在突尼斯是一个严重的公共卫生问题。2016 年，突尼斯地区启动了一项基于粪便免疫化学潜血试验的筛查计划，如果试验结果为阳性，则进一步进行结肠镜检查。我们旨在评估该筛查计划，以便为未来更好地实施该计划提出建议。
采用混合方法，定量部分基于与活动、监测和筛查质量相关的指标的产生；定性部分通过与一线卫生保健专业人员（HCP）进行焦点小组讨论和对阳性筛查试验后失访者进行个别访谈进行。然后进行 SWOT 分析，以评估该计划的主要优势、劣势、机会和威胁。
本研究显示，咨询第一线保健服务的人群覆盖率为 41.2%[40.5-41.8]，有效参与率估计为 23.1%[22.6-23.6]。在进行的 5856 次检测中，有 6%（n=352）为不可治疗性病变，6.7%（n=390）为阳性。在检测结果为阳性的人群中，仅有 18.6%（n=72）接受了结肠镜检查。共发现 26 个息肉、03 例癌症和 04 例发育不良。SWOT 分析指出，HCP 的可变性、普通人群对 CRC 筛查的认识不足、在私营部门实现结肠镜检查时缺乏镇静剂的可接受性以及公共部门预约时间过长，这些是该计划的主要劣势。
该评估强调了该计划实施的某些优势，并相应地揭示了一些缺陷，这些缺陷肯定会影响该计划的有效性和效率。将国家健康保险基金纳入 CRC 筛查试验和结肠镜检查报销范围，以及为 HCP 建立基于绩效的支付模式，是在突尼斯实现任何 CRC 大规模筛查计划取得成功和可持续性的主要关键支柱。
