贝宁、科特迪瓦和塞内加尔将宫颈癌筛查和治疗试点项目整合到常规初级卫生保健服务中吸取的经验教训。
Lessons Learnt From Pilot Cervical Cancer Screening and Treatment Programmes Integrated to Routine Primary Health Care Services in Benin, Cote d'Ivoire, and Senegal.
机构信息
Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
Department of Obstetrics and Gynaecology, Lagoon Mother and Child University Hospital Center, Faculty of Health Science, University of Abomey Calavi, Cotonou, Benin.
出版信息
JCO Glob Oncol. 2022 Sep;8:e2200051. doi: 10.1200/GO.22.00051.
PURPOSE
The project aimed to implement pilot screening and treatment services for cervical cancer integrated with existing primary health centers (PHCs) in Benin, Cote d'Ivoire, and Senegal and evaluate these services using implementation research outcomes such as reach, effectiveness, adoption, and acceptability.
MATERIALS AND METHODS
The Ministry of Health in each country took the lead in setting up a stakeholder's group that designed a protocol tailored to the local context. The target age was 25-49 years in Benin and Cote d'Ivoire and 30-49 years in Senegal. Visual inspection with acetic acid (VIA) was the screening test, and thermal ablation (TA) was the ablative treatment of choice in all. The Ministry in each country identified 4-5 PHCs to set up screening and ablation services and one higher-level center for colposcopy referral. After a master-trainer led training program, nurses, midwives, or general practitioners screened opportunistically the eligible women attending the clinics. The VIA-positive women eligible for ablation were offered immediate treatment.
RESULTS
Between May 2018 and January 2021, 16,530 women were screened opportunistically. VIA positivity was 8.1% with huge variability within and between countries. Sixty-one percent of all VIA-positive cases were eligible for immediate TA, and 88% of them accepted same-day treatment. Compliance to TA at PHCs was 99%. Majority of women treated with TA complained of minor side effects. Significant dropouts occurred as the women were referred to colposcopy clinics.
CONCLUSION
Opportunistic screening provided as part of routine PHC service can screen many women and treat a significant proportion of screen-positive women with TA with minimal side effects. Primary concerns are the hard-to-reach women who remain out of opportunistic screening coverage and noncompliance of the screen-positive women referred to higher-level centers.
目的
本项目旨在贝宁、科特迪瓦和塞内加尔的现有基层医疗中心（PHC）内实施宫颈癌试点筛查和治疗服务，并利用实施研究结果（如可及性、有效性、采用率和可接受性）对这些服务进行评估。
材料和方法
每个国家的卫生部都率先成立了一个利益相关者小组，该小组根据当地情况设计了一个方案。目标年龄在贝宁和科特迪瓦为 25-49 岁，在塞内加尔为 30-49 岁。醋酸视觉检查（VIA）是筛查测试，所有地区均选择热消融（TA）作为消融治疗方法。每个国家的卫生部都确定了 4-5 个 PHC 来建立筛查和消融服务，并确定了一个用于阴道镜转诊的高级中心。在主培训师领导的培训计划之后，护士、助产士或全科医生会对参加诊所的合格女性进行机会性筛查。VIA 阳性且符合消融条件的女性可立即接受治疗。
结果
2018 年 5 月至 2021 年 1 月期间，共有 16530 名女性接受了机会性筛查。VIA 阳性率为 8.1%，各国之间和各国内部的差异很大。所有 VIA 阳性病例中，有 61%有资格立即接受 TA，其中 88%接受了当天的治疗。PHC 对 TA 的依从率为 99%。接受 TA 治疗的大多数女性抱怨有轻微的副作用。由于这些女性被转诊到阴道镜诊所，因此出现了大量的中途退出情况。
结论
作为常规 PHC 服务的一部分提供的机会性筛查可以对许多女性进行筛查，并使用 TA 对大量 VIA 阳性女性进行治疗，副作用极小。主要关注的是那些难以接触到的女性，她们仍然无法接受机会性筛查，以及被转诊到更高一级中心的 VIA 阳性女性的不遵医嘱。
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