The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned

Figures & Tables

TABLE 1 Results of VIA Screening in Ethiopia by Region, August 2010 to March 2014

	Addis Ababa (2 sites)	Amhara (3 sites)	Oromia (3 sites)	SNNPR (3 sites)	Tigray (3 sites)	Total (14 sites)
Screening^a	n = 2,066	n = 5,688	n = 2,574	n = 2,619	n = 3,577	n = 16,524
VIA+	245 (11.9%)	416 (7.3%)	258 (10.0%)	343 (13.1%)	394 (11.0%)	1,656 (10.0%)
VIA−	1,806 (87.4%)	5,229 (91.9%)	2,303 (89.5%)	2,258 (86.2%)	3,179 (88.9%)	14,775 (89.4%)
Suspect cancer	15 (0.7%)	43 (0.8%)	13 (0.5%)	18 (0.7%)	4 (0.1%)	93 (0.6%)
Eligibility among VIA+	n = 245	n = 416	n = 258	n = 343	n = 394	n = 1,656
Cryotherapy eligible	217 (88.6%)	395 (95.0%)	251 (97.3%)	316 (92.1%)	349 (88.8%)	1,528 (92.3%)
LEEP eligible	28 (11.4%)	21 (5.0%)	7 (2.7%)	27 (7.9%)	45 (11.2%)	128 (7.7%)

Abbreviations: LEEP, loop electrosurgical excision procedure; SNNPR, Southern Nations, Nationalities, and People's Region; VIA, visual inspection of the cervix with acetic acid wash.
↵a Three inconclusive VIA test results are excluded from this table.

TABLE 2 Treatment Results of the Single-Visit Approach in Ethiopia by Region, August 2010 to March 2014

	Addis Ababa (2 sites)	Amhara (3 sites)	Oromia (3 sites)	SNNPR (3 sites)	Tigray (3 sites)	Total (14 sites)
Cryotherapy eligible	n = 217	n = 395	n = 251	n = 316	n = 349	n = 1,528
Received cryotherapy	202 (93.1%)	394 (99.7%)	236 (94.0%)	300 (94.9%)	349 (100.0%)	1,481 (96.9%)
Did not receive cryotherapy	15 (6.9%)	1 (0.3%)	15 (6.0%)	16 (5.1%)	0 (0.0%)	47 (3.1%)
LEEP eligible	n = 28	n = 21	n = 7	n = 27	n = 45	n = 128
Received LEEP	22 (78.6%)	1 (4.8%)	3 (42.9%)	15 (55.6%)	39 (86.7%)	80 (62.5%)
Did not receive LEEP	6 (21.4%)	20 (95.2%)	4 (57.1%)	12 (44.4%)	6 (13.3%)	48 (37.5%)

Abbreviations: LEEP, loop electrosurgical excision procedure; SNNPR, Southern Nations, Nationalities, and People's Region.

TABLE 3 One-Year Follow-Up Results of the Single-Visit Approach in Ethiopia by Region, August 2010 to March 2014

	Addis Ababa (2 sites)	Amhara (3 sites)	Oromia (3 sites)	SNNPR (3 sites)	Tigray (3 sites)	Total (14 sites)
Women expected for the rescreening	n = 178	n = 277	n = 188	n = 272	n = 286	n = 1,201
Returned for rescreening	53 (29.8%)	153 (55.2%)	71 (37.8%)	105 (38.6%)	232 (81.1%)	614 (51.1%)
Did not return for rescreening	125 (70.2%)	124 (44.8%)	117 (62.2%)	167 (61.4%)	54 (18.9%)	587 (48.9%)
Follow-up screening test results	n = 52	n = 153	n = 71	n = 105	n = 232	n = 613
VIA	40 (76.9%)	143 (93.5%)	63 (88.7%)	96 (91.4%)	208 (89.7%)	550 (89.6%)
VIA+	12 (23.1%)	10 (6.5%)	7 (9.9%)	9 (8.6%)	24 (10.3%)	62 (10.1%)
Suspect cancer	0 (0.0%)	0 (0.0%)	1 (1.4%)	0 (0.0%)	0 (0.0%)	1 (0.2%)

Abbreviations: SNNPR, Southern Nations, Nationalities, and People's Region; VIA, visual inspection of the cervix with acetic acid wash.

TABLE 4 Key Single-Visit Approach Findings From the Health Facility Assessment, Ethiopia, 2013

Health System Areas	Key Observations
Infrastructure
Electricity	Interruption in power supply was noted at all 14 sites.
Back-up generator	All 14 sites had back-up generators; however, 1 site did not have back-up system connected to the CCP room.
Water supply	10 of 14 sites noted frequent interruption to water supply.
Examination rooms	All 14 sites had a private room for CCP services; however, about one-quarter (4 of 14) of the sites had rooms that were of insufficient size.
Equipment and Supplies
Cryo-machine	Over one-quarter (4 of 14) of the sites reported a problem with the cryo-machine.
Spare parts	Majority of sites (12 of 14) had an extra O-ring available.
CCP supplies	About three-quarters (10 of 14) of the sites had all the necessary CCP supplies available with no shortages detected.
Other equipment	A few sites (2 of 14) noted that the examination lamp was not functional and required maintenance.
Staff
Retention	Three-quarters (57 of 77) of health workers that were trained in SVA were still working at the same site.
Workload	Majority of SVA providers at all 14 sites complained of the workload as they were also assigned to a different service unit on the same working day.