Alternative cervical cancer prevention in low-resource settings: Experiences of visual inspection by acetic acid with single-visit approach in the first five provinces of Thailand

Aust N Z J Obstet Gynaecol. 2007 Feb;47(1):54-60. doi: 10.1111/j.1479-828X.2006.00680.x.

Abstract

Background: After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single-visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low-resource settings such a high coverage is still hard to attain by the conventional Pap smear approach.

Aims: To evaluate whether VIA/SVA can increase women's access to the prevention services in low-resource provinces of Thailand.

Methods: A cross-sectional study was conducted by analysing electronic screening records of the provinces. A chi2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998-2005.

Results: This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362,300 (66.8%) in the first year.

Conclusion: VIA/SVA has provided good screening coverage and lowered the financial burden in five low-resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low-resource areas.

Publication types

  • Comparative Study

MeSH terms

  • Acetic Acid*
  • Adult
  • Cross-Sectional Studies
  • Cryosurgery / economics
  • Cryosurgery / statistics & numerical data
  • Female
  • Health Resources
  • Health Services Accessibility
  • Humans
  • Indicators and Reagents
  • Mass Screening / economics
  • Mass Screening / methods*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Rural Population
  • Sensitivity and Specificity
  • Thailand
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / surgery

Substances

  • Indicators and Reagents
  • Acetic Acid