Department of OB& GYN, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Khunying Kobchitt Limpaphayom , Wachara Eamratsameekool , Bandit Chumworathayi
Background: Cervicare Thailand is a visual inspection using acetic acid(VIA)and cryotherapy in a single visit approach(SVA) project that was initiated by Jhpiego,an affiliate of the Johns Hopkins University, and funded by Bill and Melinda Gates Foundation. Since 2002 the program has been supported locally. Purpose of this paper is to report of the results of scale up of the cervical cancer prevention initiative. Methods: The cervical cancer screening and treatment data were retrieved from service statistics that were routinely report in national health information system.We focused our data capture and analysis on 34 provinces where SVA is available. Additionally we utilized reports of training to supplement our data review. Results: Since 2000, there were 63 courses for SVA resulted in 1388 nurses qualified provide SVA in 34 of 77 provinces across Thailand. Another 149 clinical trainers were prepared to assist in training more providers and also conduct supportive supervision .Up to December 2013,749,407(22.8%)from a total of 3,285,585 women aged 30-45 have been screened with VIA. Positive VIA result were found in 27,978(3.7%) of which 15,396(55.0%) received treatment with cryotherapy at the same visit. The number of VIA positive cases referred for additional care was 12,582(45%).The referral were gynecologic problem and/or lesion ineligible for cryotherapy. Another 9,101(1.2%) women had suspicious cervical cancer finding, which required further diagnosis and treatment. Conclusions: SVA can be provided and made sustainable in Thailand. This approach increased accessibility and addresses health inequity for women in remote area.The scaled up has also identified the challenges and issue attendant to scaling up as well as the key lesson learned in improving the cervical cancer prevention in Thailand. While impact has yet to be measured nationally, the report from one of the province is promising. Roi-et where they have fully scaled up SVA, hospital based cancer registry show a declining trend for invasive cervical cancer year 2006 and 2011, reporting a drop from 65 cases to 54 cases.
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