12222David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Department of Internal Medicine, 12222University of California at Los Angeles, Los Angeles, CA, USA.
Int J STD AIDS. 2021 Sep;32(10):933-939. doi: 10.1177/09564624211007260. Epub 2021 Apr 28.
Malawi has the highest incidence of and mortality rate due to cervical cancer in the world. This is largely because of inadequate screening and high rates of human immunodeficiency virus (HIV) infection, which greatly increases cervical cancer risk. We describe the implementation of a quality improvement program to increase use of cervical cancer screening at a non-government medical center in Lilongwe, Malawi. The intervention, developed and launched from March to August 2017, aimed to promote education among patients and clinicians about the importance of cervical cancer screening and improve accessibility of screening information within medical records. Visual inspection with acetic acid (VIA) was used to screen for cervical cancer. Women with a positive VIA were offered treatment using thermocoagulation. The number of VIA screenings conducted in 2016 (pre-intervention), 2017 (intervention), and 2018 (post-intervention) was 125, 234 and 456, respectively. Of the 815 women screened during this period, 36 (4.4%) had a VIA-positive result and 12 (1.5%) had suspect cancer. Of the VIA-positive women, 13 (36.1%) received same-day treatment with thermocoagulation. An interrupted time series regression revealed that there was a sustained increase in monthly screenings between the pre- and post-intervention period ( = 30.84; = 0.006; 95% CI 9.72-51.97), suggesting that the intervention likely was effective in increasing cervical cancer screening. Our results demonstrate that focusing on developing sustainable solutions and improving system processes, without additional equipment or funding, significantly increased the number of women screened and should be considered in other settings to enhance cervical cancer prevention services.
马拉维的宫颈癌发病率和死亡率居世界首位。这在很大程度上是由于筛查不足和艾滋病毒（HIV）感染率高，这大大增加了宫颈癌的风险。我们描述了在马拉维利隆圭的一家非政府医疗机构实施质量改进计划以增加宫颈癌筛查的使用情况。该干预措施于 2017 年 3 月至 8 月开发并推出，旨在提高患者和临床医生对宫颈癌筛查重要性的认识，并改善病历中筛查信息的可及性。使用醋酸视觉检查（VIA）筛查宫颈癌。对 VIA 阳性的妇女提供热凝治疗。2016 年（干预前）、2017 年（干预中）和 2018 年（干预后）进行的 VIA 筛查数量分别为 125、234 和 456。在此期间筛查的 815 名妇女中，36 名（4.4%）VIA 阳性，12 名（1.5%）有可疑癌症。在 VIA 阳性的妇女中，有 13 名（36.1%）当天接受了热凝治疗。中断时间序列回归显示，干预前和干预后期间每月筛查次数持续增加（ = 30.84； = 0.006；95%CI9.72-51.97），这表明干预措施可能有效增加了宫颈癌筛查。我们的结果表明，专注于开发可持续解决方案和改进系统流程，而无需额外的设备或资金，可以显著增加接受筛查的妇女人数，这在其他环境中也应加以考虑，以加强宫颈癌预防服务。
