Volume 124, Issue 1 p. 12-18
Clinical articles

Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya

Kareem Khozaim

Corresponding Author

Kareem Khozaim

Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA

Corresponding author at: 550 North University Blvd, Suite 2440, Indianapolis, IN 46202, USA. Tel.: + 1 513 379 3982; fax: + 1 317 948 7454.Search for more papers by this author
Elkanah Orang'o

Elkanah Orang'o

Moi Teaching and Referral Hospital, Eldoret, Kenya

Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya

Search for more papers by this author
Astrid Christoffersen-Deb

Astrid Christoffersen-Deb

Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada

Search for more papers by this author
Peter Itsura

Peter Itsura

Moi Teaching and Referral Hospital, Eldoret, Kenya

Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya

Search for more papers by this author
John Oguda

John Oguda

Moi Teaching and Referral Hospital, Eldoret, Kenya

Search for more papers by this author
Hellen Muliro

Hellen Muliro

Moi Teaching and Referral Hospital, Eldoret, Kenya

Search for more papers by this author
Jackline Ndiema

Jackline Ndiema

Moi Teaching and Referral Hospital, Eldoret, Kenya

Search for more papers by this author
Grace Mwangi

Grace Mwangi

Moi Teaching and Referral Hospital, Eldoret, Kenya

Search for more papers by this author
Matthew Strother

Matthew Strother

Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA

Search for more papers by this author
Susan Cu-Uvin

Susan Cu-Uvin

Department of Obstetrics and Gynecology and Department of Medicine, Brown University School of Medicine, Providence, USA

Search for more papers by this author
Barry Rosen

Barry Rosen

Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada

Search for more papers by this author
Sierra Washington

Sierra Washington

Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA

Moi Teaching and Referral Hospital, Eldoret, Kenya

Search for more papers by this author
First published: 25 September 2013
Citations: 53
Presented as a poster at the 14th Biennial Meeting of the International Gynecologic Cancer Society; October 13–16, 2012; Vancouver, Canada.

Abstract

Objective

To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya.

Methods

The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011.

Results

In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and 10.9% had invasive cancer. There were 68 cases of cancer, equating to approximately 414 per 100 000 women per year. Despite aggressive strategies, the overall loss to follow-up was 31.5%: 27.9% were lost after a positive VIA screen, 49.3% between biopsy and LEEP, and 59.6% between biopsy and hysterectomy/chemotherapy.

Conclusion

The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.