Situation Analysis of Cervical Cancer Screening by Visual Inspection with Acetic Acid in Roi-Et Province

Abstract

A cervical cancer screening aims for early detection of the precancerous lesions and  provision of the appropriate treatment before the lesion advances to cancer 10-20 years later. However, in low - resource settings the screening coverage is low. The Visual Inspection with acetic acid (VIA) program was first implemented in Thailand as a pilot project in 4 districts of Roi Et in 2000 and has been expanded to primary care settings throughout the province in 2002. It has been expected this approach could increase the coverage of cervical cancer screening in the target women. The purpose of this study is to assess the situation of program effectiveness with respect to the coverage rate between 1998-2006. Data of VIA screening between 2002-2006 were obtained from electronic screening records which included 101,205 screening visits totally, where as data of VIA screening in 1998 and Pap smear screening between 1998-2006 were obtained from monthly annual performance reports of The Corresponding Provincial Health Office. This study shows that the 5-year cumulative coverage (2002-2006) by VIA based on number of women 30-45 years in 2006 was 47.2%. The new screening coverage rate by VIA and Pap smear increased from 3.4% to 6.1% after VIA expanded throughout the province and increased from 7.9% to 10.1% after The National Health Security Board allocates budget to support cervical cancer prevention and control program through vertical program. The percentage of VIA screenings as a proportion of all new screening of women aged 30-60 was 68%, on average. Women aged 30-45 had the highest screening coverage. The highest proportions of VIA tests were screened at District hospital level. Barrier to cervical cancer screening in supply side is insufficient of service provider. Factors associated demand side such as the immigration of target women, embarrassment, lack of knowledge and perceived information about cervical cancer are barriers to screening among women. This study provides that VIA is a potential alternative screening method of cervical cancer prevention in the low coverage screening, low resource settings like rural areas in Thailand.