Int Health 2018; 10: 197–201 doi:10.1093/inthealth/ihy014 Advance Access publication 22 March 2018 Implementation of a human papillomavirus screen-and-treat model in Mwanza, Tanzania: training local healthcare workers for sustainable impact Megan Bernstein a , Anjali Hari b , Sahil Aggarwal a, *, Debora Lee a , Allison Farfel a , Priya Patel a , Kaavya Raman a , Shella Raja a , Reece Fenning a , Mark Lieber a , William Minteer a , Sean Denny a and Maureen Ries b a University of California, Irvine School of Medicine, Irvine, CA, USA; b University of California, Los Angeles, Department of Obstetrics and Gynecology, Los Angeles, CA, USA *Corresponding author: E-mail: sahila@uci.edu Received 31 August 2017; revised 12 February 2018; editorial decision 14 February 2018; accepted 14 February 2018 Background: The purpose of this study is to evaluate the development of a 1-wk screening campaign and efforts towards the implementation of a sustainable system that addresses cervical cancer in Mwanza, Tanzania with a screen-and-treat model utilizing visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Methods: In partnership with CureCervicalCancer (CCC), a non-profit organization based in Los Angeles, CA, USA, 11 medical students at the University of California, Irvine School of Medicine established a model for sus- tainable human papillomavirus screening practices in Mwanza, Tanzania. This study both quantitatively and qualitatively assesses the successes and limitations of the program model. Results: During the 5-day training, a total of 614 women attended the screenings and 556 women were screened with VIA, of whom 10.6% (n=59) were VIA positive and 89.4% (n=499) were VIA negative. Of those who were VIA positive, 83.1% (n=49) received cryotherapy while 16.9% (n=10) did not due to suspicion of advanced cancer (n=7), refusal to receive cryotherapy (n=2) or pregnancy (n=1). Conclusions: The screen-and-treat model for the identification and treatment of precancerous cervical lesions is an effective public health intervention with the potential to impact women by providing the tools and edu- cation needed by local healthcare professionals. However, limitations common to resource-poor settings, such as continuity of funding, loss to follow-up and transportation costs, remain barriers to sustainability. Keywords: Africa, human papilloma virus, screening, tanzania Introduction Cervical cancer is the fourth most common cancer in women glo- bally, with 528 000 new cases and 266 000 deaths annually. 1 Of these cases, 84.2% are found in less developed countries, with East Africa carrying the largest burden of any region. 1 Nearly all instances of cervical cancer are the result of repeated human papillomavirus (HPV) infections, which cause histopathological changes of the cervical transformation zone, 2 an anatomical transition normally present in the cervical mucosa that delineates the border between squamous and columnar metaplasia. As a result of this finding, regional efforts to reduce cervical cancer rates have focused on access to HPV vaccinations and early detection of precancerous lesions via screening. 3 Human immunodeficiency virus (HIV) co-infection with HPV has also been identified as a risk factor for developing cervical cancer, thus affecting global regions where HIV has been a long-standing concern. 4 In order to enable more cost-effective screening options for precancerous cervical lesions, the visual inspection method using acetic acid (VIA) was developed as an accurate detection alternative to more expensive cytological testing. 5,6 In addition to VIA for screening, cryotherapy is a simple yet effective way for VIA-positive patients to be treated prior to the progression of the lesion to cervical cancer. 7 The combination of VIA and cryotherapy has become a widely accepted low-cost option that can be performed in a single screen-and-treat visit 6,8 and ORIGINAL ARTICLE © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 197 Downloaded from https://academic.oup.com/inthealth/article/10/3/197/4951437 by guest on 31 December 2021