VIAVisual Inspection with Acetic

Acid of the Cervix UteriUsing Acetic Acid for Cervix Screening in Resource

poor Settings

Dr Dirk Grothuesmannhttp://dg-maternalhealth.de/

Reasoning of VIA

Majority of pre-invasive and invasive Lesions of the Cervix are visible by “Naked Eye” Examination following Acetic Acid Application• Application of 5% Acetic Acid followed by Inspection with Halogen Lamp• Acetowhitening = VIA positive• No Acteowhitening = VIA negative

White Color due to increased Protein and Nuclear Proteins and Cytokeratin in the cervical Epithelium by CIN+

WHO, 2012

“Screen and Treat” Approach

• Single-visit Approach enables Clients to be screened and treated on the same Day• VIA and Cryotherapy Procedures are well tolerated• “Screen and Treat” Approach can be introduced into existing Reproductive

Health Services in Low-Resource Countries• Screening utilizing VIA, and Treatment with Cryotherapy, is acceptable and

feasible at low-level Health Facilities• VIA is an attractive Alternative to cytology-based Screening in Low-Resource

Settings

WHO, 2014

Cryotherapy• Easier to implement than other Treatment modalities such as loop

Electrosurgical Excision Procedure (LEEP), loop excision of the Transformation Zone (LETZ) and Cone Biopsy• Affordable Treatment• Can be done in primary Health-Care Settings• Feasibility Aspects have been proven in WHO Projects

Exclusion Criteria for VIA and Cryotherapy and Eligibility

Criteria for Cryotherapy

WHO, 2012

Cryotherapy

Cryotherapy

Limitations

• “See and Treat” Strategy leads to Overtreatment• VIA less effective for elderly Patients because TZ tendency to retreat

endocervical• VIA results are subjective to the Observer• Although VIA is a sensitive screening Test it can not be used by itself• Low Positive Predicative Value (PPV) of 10 – 20%

Mustafa et al, 2010

Advantages

• Test is inexpensive• Can be performed with minimal Infrastructure• Test Result are immediately available• Training Period to acquire the Skills is short• Can be done under flied conditions by auxiliary health Workers (when

trained accordingly)

LiteraturePrevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy, WHO, 2012, from http://apps.who.int/iris/bitstream/10665/75250/1/9789241503860_eng.pdf

Sellors JW and Sankaranarayanan R, 2003, Colposcopy and Treatment of Cervical Intraepithelial Neoplasia: A Beginners’ Manual, International Agency for Research on Cancer, Lyon, from http://screening.iarc.fr/doc/Colposcopymanual.pdf

WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ, WHO, 2014, from http://apps.who.int/iris/bitstream/10665/104174/1/9789241506779_eng.pdf

Visual inspection using acetic acid for cervical cancer screening in low resource settings, MJAFI, 2010, 66, 382-384, Maj MS Mustafa, Col Ak Jingdal, Col PMP Singh, from http://medind.nic.in/maa/t10/i4/maat10i4p382.pdf

Annexe:5% Acetic Acid and Lugol’s Iodine

Sellors and Sankaranarayanan , 2003

Aim of my Project

Dr. Dirk Grothuesmann ConsultancyImproving Maternal Health and Gynecology Services by Training Health Care Providers: Relaying on standardized training modules I teach evidence-based obstetrical procedures, gynecology surgery and related evaluation tools to local personnel in developed and developing countries. Completing the programs offered, skills gained enable to serve women in need in any requested setting.http://dg-maternalhealth.de/index2.html

http://dg-maternalhealth.de/

Dr Dirk Grothuesmann

Consultancy