Dalrada Health

VIA

SCREENING

divider
basic via kit

World Health Organization (WHO) makes global call for action toward the elimination of cervical cancer.

Cervical cancer is one of the most preventable and treatable forms of cancer – as long as it is detected early, treated with HPV vaccination, and managed effectively. Prevention and early treatment are highly cost-effective and efficient. Worldwide, however, cervical cancer remains one of the gravest threats to women and globally, one woman dies from the disease every two minutes. The number of women that this disease affects and the suffering it causes is unacceptable and cannot continue.
Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy

A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia

AUTHORS:

African Population and Health Research Center, International Agency for Research on Cancer, World Health Organization.

In conclusion, as a result of a demonstration project, visual inspection with acetic acid (VIA) cryotherapy has been incorporated into the cervical cancer-prevention services in existing reproductive health services in six African countries. VIA is an attractive alternative to cytology-based screening in limited-resource areas. Similarly, cryotherapy has been selected as the treatment option for eligible test-positive cases. This simple and safe cervical cancer-prevention technique simplifies
the process and renders it feasible and more acceptable to women as well as providers in limited-resource
settings.

Scaling up these programs will facilitate further extension of cervical cancer-prevention services to the target population in both urban and rural areas through development of referral linkages with high-level health facilities. Recommendations provided in this report can help facilitate phased and
coordinated scaling of services in the six countries mentioned.

INTRODUCTION

One out of every five women in the world suffering from this disease lives in India. More than three-fourths of these patients are diagnosed at advanced stages leading to poor prospects of long-term survival or cure.

Early screening for cervical cancer can detect the disease at a precancerous stage when it is amenable to simple treatment and ultimately, cure. In many developed countries, the annual incidence and mortality rates from this type of cancer have been reduced by 50-70% since the introduction of population-based screening.

While cytology-based screening programs have been effective in other developed countries, for a large population of India, the infrastructure and resources do not permit Pap Smear-based screening programs except in very limited settings.

GUIDELINE

Visual inspection-based approaches to cervical cancer screening have been extensively investigated in India. The performance characteristics of unaided visual inspection (without acetic acid), suffers from low sensitivity and specificity to detect cervical neoplasia, particularly the precursor lesions, and is no longer recommended as a screening approach.

In 2006, the National Cancer Control Program released a document on guidelines for cervical cancer screening in India through the country’s existing health care system.

The recommendation (then and now) is to screen women between the ages of 30 and 59 using visual
inspection with acetic acid at primary health centers.

Similar recommendations have been made by the WHO.

EVIDENCE

Several studies were conducted in India and around the world that show the effectiveness of a VIA-based screening approach.

In India, cervical cancer mortality was reduced by 31% over a period of 15 years among women screened with visual inspection with acetic acid when delivered by primary health workers in a
randomized study conducted among 150,000 women.

The studies concluded that VIA screening, in the presence of good training and sustained quality assurance, is an effective method that prevents cervical cancer in countries that have large low-to-medium income-growing populations.

VIA KIT / PROCESS VALIDATION

The VIA kit is based on the World Health Organization’s recommended procedure for conducting VIA. It contains all the necessary elements required for the procedure to be done by a healthcare professional in a primary healthcare setting. ​

The kit has been used in clinical trials in India. Three groups carried out testing to validate the VIA process in kit for and the findings were positive for diagnosis purposes. The transition to kit form will enable screening centers to purchase and manage multiple aspects including assisting with ensuring
consistency and quality of all the components used as well as confirming that all active ingredients are sourced from FDA or ISO-approved facilities. This also ensures the validation process is consistent, as everyone will use identical components (currently, the 5% Acetic Acid mix has seen variability, particularly due to instances of manual dilution, the mixing of incorrect ingredients, or “normal” water used in place of distilled water.

During the validation process, we demonstrated the kit solution to experts in the field and made minor modifications based on professional feedback to include specific items like larger swabs, certain disposable elements, and even a bio-hazard disposal bag.

VIA

SCREENING

divider
basic via kit

World Health Organization (WHO) makes global call for action toward the elimination of cervical cancer.

Cervical cancer is one of the most preventable and treatable forms of cancer – as long as it is detected early, treated with HPV vaccination, and managed effectively. Prevention and early treatment are highly cost-effective and efficient. Worldwide, however, cervical cancer remains one of the gravest threats to women and globally, one woman dies from the disease every two minutes. The number of women that this disease affects and the suffering it causes is unacceptable and cannot continue.
Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy

A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia

AUTHORS:

African Population and Health Research Center, International Agency for Research on Cancer, World Health Organization.

In conclusion, as a result of a demonstration project, visual inspection with acetic acid (VIA) cryotherapy has been incorporated into the cervical cancer-prevention services in existing reproductive health services in six African countries. VIA is an attractive alternative to cytology-based screening in limited-resource areas. Similarly, cryotherapy has been selected as the treatment option for eligible test-positive cases. This simple and safe cervical cancer-prevention technique simplifies the process and renders it feasible and more acceptable to women as well as providers in limited-resource settings.

Scaling up these programs will facilitate further extension of cervical cancer-prevention services to the target population in both urban and rural areas through development of referral linkages with high-level health facilities. Recommendations provided in this report can help facilitate phased and coordinated scaling of services in the six countries mentioned.

INTRODUCTION

One out of every five women in the world suffering from this disease lives in India. More than three-fourths of these patients are diagnosed at advanced stages leading to poor prospects of long-term survival or cure.

Early screening for cervical cancer can detect the disease at a precancerous stage when it is amenable to simple treatment and ultimately, cure. In many developed countries, the annual incidence and mortality rates from this type of cancer have been reduced by 50-70% since the introduction of population-based screening.

While cytology-based screening programs have been effective in other developed countries, for a large population of India, the infrastructure and resources do not permit Pap Smear-based screening programs except in very limited settings.

GUIDELINE

Visual inspection-based approaches to cervical cancer screening have been extensively investigated in India. The performance characteristics of unaided visual inspection (without acetic acid), suffers from low sensitivity and specificity to detect cervical neoplasia, particularly the precursor lesions, and is no longer recommended as a screening approach.

In 2006, the National Cancer Control Program released a document on guidelines for cervical cancer screening in India through the country’s existing health care system.

The recommendation (then and now) is to screen women between the ages of 30 and 59 using visual inspection with acetic acid at primary health centers.

Similar recommendations have been made by the WHO.

EVIDENCE

Several studies were conducted in India and around the world that show the effectiveness of a VIA-based screening approach.

In India, cervical cancer mortality was reduced by 31% over a period of 15 years among women screened with visual inspection with acetic acid when delivered by primary health workers in a randomized study conducted among 150,000 women.

The studies concluded that VIA screening, in the presence of good training and sustained quality assurance, is an effective method that prevents cervical cancer in countries that have large low-to-medium income-growing populations.

VIA BASIC KIT / PROCESS VALIDATION

The VIA Basic kit is based on the World Health Organization’s recommended procedure for conducting VIA. It contains all the necessary elements required for the procedure to be done by a healthcare professional in a primary healthcare setting. ​

The kit has been used in clinical trials in India. Three groups carried out testing to validate the VIA process in kit for and the findings were positive for diagnosis purposes. The transition to kit form will enable screening centers to purchase and manage multiple aspects including assisting with ensuring consistency and quality of all the components used as well as confirming that all active ingredients are sourced from FDA or ISO-approved facilities. This also ensures the validation process is consistent, as everyone will use identical components (currently, the 5% Acetic Acid mix has seen variability, particularly due to instances of manual dilution, the mixing of incorrect ingredients, or “normal” water used in place of distilled water.

During the validation process, we demonstrated the kit solution to experts in the field and made minor modifications based on professional feedback to include specific items like larger swabs, certain disposable elements, and even a biohazard disposal bag.

VIA

SCREENING

divider
basic via kit

World Health Organization (WHO) makes global call for action toward the elimination of cervical cancer.

Cervical cancer is one of the most preventable and treatable forms of cancer – as long as it is detected early, treated with HPV vaccination, and managed effectively. Prevention and early treatment are highly cost-effective and efficient. Worldwide, however, cervical cancer remains one of the gravest threats to women and globally, one woman dies from the disease every two minutes. The number of women that this disease affects and the suffering it causes is unacceptable and cannot continue.
Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy

A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia

AUTHORS:

African Population and Health Research Center, International Agency for Research on Cancer, World Health Organization.

In conclusion, as a result of a demonstration project, visual inspection with acetic acid (VIA) cryotherapy has been incorporated into the cervical cancer-prevention services in existing reproductive health services in six African countries. VIA is an attractive alternative to cytology-based screening in limited-resource areas. Similarly, cryotherapy has been selected as the treatment option for eligible test-positive cases. This simple and safe cervical cancer-prevention technique simplifies the process and renders it feasible and more acceptable to women as well as providers in limited-resource settings.

Scaling up these programs will facilitate further extension of cervical cancer-prevention services to the target population in both urban and rural areas through development of referral linkages with high-level health facilities. Recommendations provided in this report can help facilitate phased and coordinated scaling of services in the six countries mentioned.

INTRODUCTION

One out of every five women in the world suffering from this disease lives in India. More than three-fourths of these patients are diagnosed at advanced stages leading to poor prospects of long-term survival or cure.

Early screening for cervical cancer can detect the disease at a precancerous stage when it is amenable to simple treatment and ultimately, cure. In many developed countries, the annual incidence and mortality rates from this type of cancer have been reduced by 50-70% since the introduction of population-based screening.

While cytology-based screening programs have been effective in other developed countries, for a large population of India, the infrastructure and resources do not permit Pap Smear-based screening programs except in very limited settings.

GUIDELINE

Visual inspection-based approaches to cervical cancer screening have been extensively investigated in India. The performance characteristics of unaided visual inspection (without acetic acid), suffers from low sensitivity and specificity to detect cervical neoplasia, particularly the precursor lesions, and is no longer recommended as a screening approach.

In 2006, the National Cancer Control Program released a document on guidelines for cervical cancer screening in India through the country’s existing health care system.

The recommendation (then and now) is to screen women between the ages of 30 and 59 using visual inspection with acetic acid at primary health centers.

Similar recommendations have been made by the WHO.

EVIDENCE

Several studies were conducted in India and around the world that show the effectiveness of a VIA-based screening approach.

In India, cervical cancer mortality was reduced by 31% over a period of 15 years among women screened with visual inspection with acetic acid when delivered by primary health workers in a randomized study conducted among 150,000 women.

The studies concluded that VIA screening, in the presence of good training and sustained quality assurance, is an effective method that prevents cervical cancer in countries that have large low-to-medium income-growing populations.

VIA BASIC KIT / PROCESS VALIDATION

The VIA Basic kit is based on the World Health Organization’s recommended procedure for conducting VIA. It contains all the necessary elements required for the procedure to be done by a healthcare professional in a primary healthcare setting. ​

The kit has been used in clinical trials in India. Three groups carried out testing to validate the VIA process in kit for and the findings were positive for diagnosis purposes. The transition to kit form will enable screening centers to purchase and manage multiple aspects including assisting with ensuring consistency and quality of all the components used as well as confirming that all active ingredients are sourced from FDA or ISO-approved facilities. This also ensures the validation process is consistent, as everyone will use identical components (currently, the 5% Acetic Acid mix has seen variability, particularly due to instances of manual dilution, the mixing of incorrect ingredients, or “normal” water used in place of distilled water.

During the validation process, we demonstrated the kit solution to experts in the field and made minor modifications based on professional feedback to include specific items like larger swabs, certain disposable elements, and even a biohazard disposal bag.

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