1. VIA Screen-and-Treat Cervical Cancer Prevention in Guyana: A Mobile Clinic Pilot Project to a Remote Amerindian Community John E. Varallo, MD, MPH, FACOG - Omni Med, Waban, MA; and Orrin Liddell, MBBS - Dept. of Obstetrics and Gynaecology, Georgetown Public Hospital Corporation, Georgetown, Guyana Main reasons for such high cervical cancer rates 1.Major logistical and technical barriers associated with traditional, multistep, cytology-based screening, such as: Poor access to screening and treatment services Poor linkage of screening with treatment Limited cytopathology services 2. Sociocultural, behavioral, and HPV issues To assess the feasibility, accuracy, safety, and acceptability of performing visual inspection with acetic acid (VIA) with same-day treatment in a mobile clinic to a remote Amerindian community in Guyana A two day cross-sectional study of women living in and around Moruca, an Amerindian village in the remote interior of Guyana. Except for the lead author, all mobile clinic personnel were Guyanese. Team members were trained/supervised by the lead author. All necessary equipment and supplies were transported to the remote clinic site by the mobile clinic team. VIA screening was conducted in the mornings, following a strict protocol. Screen-positive women were treated the same afternoon as their screening. Treatment consisted of Loop Electrosurgical Excision Procedure (LEEP). Tissue specimens were processed at Guyana’s main referral laboratory. Training at main public hospital Travel to interior via multiple boat trips up rivers Moruca - main street/boat launch Mobile clinic waiting area 1.An evidence-based alternative approach to cytological (Pap smears) cervical cancer screening (2, 3, 4, 5). Safe, effective, feasible and sustainable in low-resource settings 2.Relatively simple technique: Clean cervix with 3-5% acetic acid solution (white vinegar) After one minute, visualize cervix with unaided eye - abnormal areas turn whitish. 3.Provides immediate results, allowing immediate treatment or triage. NegativePositive Photo source: JHPIEGO References 1.Ferlay, J, (2004) “Globocan 2002: Cancer Incidence, Mortality and Prevalence Worldwide”, Descriptive Epidemiology Group, IARC, Lyon, France. Available at: http://www-depdb.iarc.fr/globocan/GLOBOframe.html (Last accessed: Sept., 2006) 2.Alliance for Cervical Cancer Prevention (2004) The Case for Investing in Cervical Cancer Prevention: Cervical Cancer Prevention Issues in Depth, No. 3, ACCP, Seattle, WA 3.Ashford, L, Collymore, Y (2004) Preventing Cervical Cancer Worldwide, Population Reference Bureau, Washington, DC 4.Sankaranarayanan, R, Gaffikin, L, Jacob, M, et al. (2005), “A critical assessment of screening methods for cervical neoplasia”, International Journal of Gynecology & Obstetrics, vol. 89, pp. S4-12 5.Goldie, SJ, Kuhn, L, Denny, L, et al. (2001), “Policy analysis of cervical cancer screening strategies in low resource settings: clinical benefits and cost- effectiveness”, JAMA, vol. 285, pp. 3107-15 6.Varallo, J, Liddell, O (2005), “Visual inspection with acetic acid as an alternative to pap smears for cervical cancer screening in Guyana”, Guyana Health Information Digest, vol. 6 (2), pp. 26-36 High VIA screen-positive rate in this population at 37.5% (27/72), compared to a previous study that revealed a 17% VIA screen-positive rate in the capital city of Georgetown (6). Immediate Results  % of women who received immediate results following VIA 100% (72/72)* Promotes Linkage with Treatment  % of VIA screen-positive women who received same-day treatment 100% (27/27) Accurate  % of VIA screen-positive women with cervical dysplasia on histopathology of LEEP specimens 93% (25/27) Safe  % of women experiencing significant complications following screening/treatment 0% (0/72) Acceptable  % of women who reported satisfaction or high satisfaction with services and would recommend other women to participate in future prevention services 100% (72/72) *In comparison, another study revealed that only 28% (27/95) of women received pap smear results or had them recorded in their charts 6 months after screening (6). Cervical cancer prevention using VIA combined with same-day treatment in a mobile clinic in Guyana is feasible, accurate, safe, and highly acceptable. This low-cost strategy is a practical alternative to dramatically expand coverage of cervical cancer prevention services in settings such as Guyana. A national policy for cervical cancer prevention based on this model (using both Cryotherapy and LEEP for treatment) has been accepted in principal. HPV typing and possible vaccination are being considered for incorporation into the national policy. Acknowledgements The authors would like to thank the following for their continued support and encouragement: Dr. Ed O’Neil and Omni Med; Dr. Madan Rambaran and Georgetown Public Hospital Corporation; Dr. Leslie Ramsammy, Sonya Roopnauth and the Ministry of Health; and Patricia Singh and the Regional Health Services. Guyana suffers among the highest cervical cancer rates in the world (1) Objective Background of VIA Methods Results Conclusions/Policy Implications