Cancer cervix screening at the infectious diseases institute

1. INFECTIOUS DISEASES INSTITUTE Cancer cervix screening at the infectious diseases institute ShadiaNakalema 10/10/2012

2. Introduction • Uganda • Overall HPV Prevalence in Uganda is 16.7% (David serwadda et al 1997 JID) • HIV +ve 44.7% • HIV –ve 10.2% • HIV prevalence rate amongst women 15-45yrs – 6.7 • Highest worldwide CaCx incidence rate (45.6/10000)

3. IDI background • 10000 patients all HIV positive • 6756 (67%) females • 7,176 (71%) on ART

4. Background of IDI program • SRH program started in 2008 • Integrated PMTCT • Family planning • STI diagnosis and treatment • Cancer cervix screening • Funded by TIDES/INTERACT

5. Methods • Screening is voluntary. • Identification points; • Patients waiting area (health talks) • Nurses station • Doctors consultations • Performed by the SRH doctor or Nurse • Technique used is Visual Inspection with 2% Acetic acid (VIA)

6. Methods • Additional data about risk factors recorded • Age, parity, sexual début, number of life long sexual partners and previous VIA results • Positive VIA - referred to gynae-oncology • Negative VIA – health information given to encourage yearly screening

7. Results • No screened (Jan 2011 to date)- 322 • Median age - 38yrs • % on ART- 71% • Median CD4- 416cells/ul • No positive – 84 (26.1%)

8. Age

9. Sexual Debut

10. Parity

11. Number of lifelong partners

12. Successes • Well trained / experienced staff • (Dr and Nurse) for SRH • Accessed dedicated space and equipment. • Increased cervical cancer awareness amongst staff and pts – interaction HIV & HPV

13. Challenges • Patient education • Patient concerned about follow up care • Relying on patients to return their histology results to the clinic means many may be missed • There is no proper referral system for patients with positive VIAs

14. THANK YOU