innovating to save lives

CHULALONGKORN UNIVERSITY

Seven-Year Follow-Up of a Large-Scale Cervical Cancer Prevention

Program in Thailand
by: Harshad Sanghvi1; Kobchitt Limpaphayom2; Wachara Earamsatmeekoo3; Lynne Gaffikin4; Elaine Charurat1; Ana Tergas5; Ricky Lu1 and
Sharon Kibwana1
affiliate: 1Jhpiego, an affiliate of Johns Hopkins University, 2Chulalongkorn University, 3Roi-et Provincial Health Office, 4Evaluation and Research
Technologies Health Inc., 5Johns Hopkins Medical Institution

What Is VIA (Visual Inspection with Acetic Methodology Summary of Diagnostic Testing Results
Acid)?  SAFE cohort actively recruited through Cohort A=565 Cohort B=3,562
postcards and home visits from village health
 Looking at the cervix to detect abnormalities volunteers. 3,562 screened with VIA
565 screened with VIA
after applying dilute (3–5%) acetic acid (vinegar)
 Previously VIA(+) women seen at the district
 Acetic acid enhances and marks a pre- hospital for a brief questionnaire, VIA 565 underwent 282 underwent
cancerous lesion by turning it a whitish hue colposcopy colposcopy
screening, colposcopically-directed biopsy and 5 hysterectomized
(aceto-white change) 39 hysterectomized
women women
endocervical curettage (ECC).
526 underwent ECC 277 underwent ECC
 Previously VIA(-) women seen at the local and/or biopsy and/or biopsy
health center for a brief questionnaire and VIA
screening: 2 CIN III 3 CIN III

 Test positive women offered treatment,

referred for colposcopically-directed biopsy
Participant Characteristics and VIA Results
and ECC at the District Hospital.
NORMAL CIN III  Results were aggregated and analyzed with 2000 VIA Screening
descriptive statistics. Results
Cohort A, Cohort B,
Why Is VIA a Practical Alternative to Cervical VIA+ in 2000 VIA– in 2000
Cancer Screening? Study Design (n=565) (n=3,560)
 Safe, easy to perform and inexpensive Women from SAFE cohort identified and contacted. Remembered being told to
491 (86.9%) 3,122 (87.7%)
 Can be learned by all types of health care come back for screening
professionals Women consented and administered HPV questionnaire. Said they came back for 2,733
526 (93.1%)
screening (76.8%)
 Uses locally available equipment and supplies
Cohort A (VIA test positive in 2000) Cohort B (VIA test negative in 2000) 2000 VIA Screening
 Comparable results and are available examined with VIA, colpo/biopsy examined with VIA. If VIA positive, Results
and ECC. referred for colpo/biopsy and ECC.
immediately: Cohort A, Cohort B,
 Sensitivity – 80%1 VIA+ in 2000 VIA– in 2000
Women were offered treatment and received post-test
 Specificity – 92%1 (treatment) counseling per Thai national protocols. (n=526) (n=2,733)
Reason for Coming Back among Those Returned
 Potential for immediate link to outpatient
Told to by health care
treatment 449 (85.4%) 1,848 (67.6%)
Response Rate provider or someone else
 Suitable for lowest-resource Worried about getting 1,353
 5,197 out of 5,999 women were successfully 34 (6.5%)
settings cancer (49.5%)
1
Sauvaget et al., 2011, IJGO.
identified
Experienced symptoms 24 (4.6%) 430 (15.7%)
 4,127 out of 5,197 women participated fully
Other 12 (2.3%) 238 (8.7%)
Background  1,090 women did not participate due to: No reason 7 (1.3%) 46 (1.7%)
 2.8% (145) declined
 February–October 2000:
SAFE (Safety, Acceptability,  12.8% (666) could not be found after several Conclusions
Feasibility and program Effort) attempts This follow-up study revealed:
Demonstration Project in Roi Et,  0.2% (13) deceased
 That the re-screen protocol
Thailand  5.1% (266) other unknown reasons was successful in getting the
 5,999 women were screened with VIA2  Overall response rate = 79.6% (4,127/5,184*) majority of the SAFE cohort
(N=5,999) 1st Visit 12 Months * exluding women who were deceased in the interim back within 5–6 years of initial
screening.
VIA-Negative 5,146 (86.7%) 3.4
VIA-Positive 798 (13.3%) 707 (93.5%) returned Participant Characteristics and VIA Results  The VIA positivity rate on
• 756 received • 667 VIA-negative follow-up screening for both
treatment • SCJ visible 2000 VIA Screening Results previously VIA-positive and
VIA-negative cohorts was low.
 Follow-up of the SAFE cohort of women after 5 Cohort A, VIA+ in Cohort B, VIA– in
years – study conducted in 2007 2000 (n=565) 2000 (n=3,562)  Based on these results, re-
Age Distribution screening with VIA at longer intervals may be
2
RTCOG, Jhpiego, 2000 Lancet.
warranted in low-resource settings.
36–40 155 (27.4%) 1,004 (28.2%)
41–45 188 (33.3%) 1,215 (34.1%)
7 Year Follow-Up Study of SAFE Cohort 46–50 187 (33.1%) 1,044 (29.3%) Contact Information
STUDY OBJECTIVES 51 and Khunying Kobchitt Limpaphayom,Professor
34 (6.0%) 292 (8.2%)
 To determine in a cohort of women: above Emeritus, Chulalongkorn University
 Positivity rate, 7 years after initially Unknown 1 (0.2%) 7 (0.2%) lkobchitt@csloxinfo.com
screened negative with visual inspection Follow-up Study VIA Screening Results
Ricky Lu, Jhpiego, an affiliate of Johns Hopkins
with acetic acid (VIA) SCJ not
28 (5.0%) 147 (4.1%) University, RH/FP/CeCaP Director
 Recurrence/persistence rate of those who visible
rlu@jhpiego.net
initially screened positive with VIA and Negative 464 (82.1%) 3,275 (91.9%)
had received treatment Positive 54 (9.6%) 133 (3.7%) Ana Tergas, Johns Hopkins Medical Institutions,
Suspect Gyne-Oncology Fellow, atergas1@jhmi.edu
1 (0.2%)
cancer
Other 18 (3.2%) 7 (0.1%)