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Community-Based Screening for Cervical Cancer Using Visual Inspection With Acetic Acid: Results and Lessons Learned
Lan T H Vu1, Hanh T D Tran, Binh Th Nguyen
1Hanoi University of Public Health, Hanoi, Vietnam (Drs Vu and Bui and Ms Tran); Provincial Department of Health, Bac Ninh, Vietnam (Dr B. T. Nguyen); Department of Gynecology and Obstetrics, Bach Mai Hospital, Hanoi, Vietnam (Dr Pham); and Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam (Dr A. D. Nguyen).
Context:
Vietnam still applies the opportunistic cytology-based screening model, which failed to have an impact on the increasing burden of cervical cancer in Vietnam.
Objectives:
To pilot a community-based screening model for cervical cancer using visual inspection with acetic acid (VIA) in Vietnam by training midwife and assistant physician working at grassroots level of health care system.
Design:
The study employed a pre-experimental design.
Setting:
Cases from 2 provinces of Vietnam.
Participants:
The study trained 36 assistant physicians/midwives working at commune health centers to do VIA screening for cervical cancer and provided screening services for 1945 women 30 to 65 years of age.
Intervention:
The pilot intervention had 2 aims: train health care workers to do VIA screening and assess the quality of screening services provided by the trained staffs by examining the diagnostics value of VIA.
Results:
All selected health care workers were able to perform VIA screening method after training. Their VIA services had high diagnostic value: positive predicted value of 11.5% and negative predicted value of 99%; for the detection of cervical intraepithelial neoplasia (CIN) 2, the sensitivity of VIA is 100%, specificity of 67.0%, positive predicted value of 5.7%, and negative predicted value of 100%; for the detection of CIN 3, the sensitivity of VIA is 100%, specificity of 66.5%, positive predicted value of 3.8%, and negative predicted value of 100%. The diagnostic value of VIA is comparable with Papanicolaou test but requires far fewer resources and suitable with community-based setting.
Conclusion:
Local midwives and assistant physicians who currently work at commune health centers and district health centers can be trained to do VIA efficiently. Regarding to implications for policy and practice, VIA can offer significant advantages over Papanicolaou test in low-resource settings like Vietnam, particularly in terms of increased screening coverage, improved follow-up care, and overall program quality.
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