May Maloba, CCSP Coordinator

August 10, 2012

FACES CCSP overview

Program emphasis

Screening protocols

M & E

Achievements

Challenges

Cervical cancer screening and prevention program (CCSP) at FACES began in October,2007

Goal is to reduce morbidity and mortality from cancer of the cervix

Scope of work-FACES CCSP Health Education Cervical cancer screening Diagnosis Treatment of precancer Research Training

Geographic areas: Kisumu , Suba

Identify, invite, screen and follow-up women in target population--increase coverage

Provide quality, appropriate, acceptable and caring services--increase participation

Develop and monitor good referral systems that ensures good follow-up--reduce incidence

Competency based training for HCWs Monitor & Evaluate program outcomes to

facilitate planning and scale up

V.I.A.

Colposcopy

Biopsy

LEEP

+ -

V.I.A. in 3 yrs

Colposcopy in 1 yr

CIN1CIN2+

CIN2+

Colposcopy in 6 mos

-

CIN1/Negative

VIA/VILI

Colposcopy

Biopsy

LEEP

V.I.A. in 3 yrs

Colposcopy in 1 yr

CIN1CIN2+

CIN2+

Colposcopy in 6 mos

-

CIN1/Negative

VIA/VILI

LEEP

- Rescreen in 3 yrs

CryotherapyNon cryo candidate

+

Includes all non-pregnant women over 23, regardless of HIV status

Lumumba/Research Screening We are using Access database to capture

all the data on our paper forms. In the process of programming OpenMRS

to help with clinical follow-up and flagging clients who are eligible for screening.

Output into Excel, can be shared or transferred to stata analysis

FACES-MOH Rollout (Suba) Standard set of M&E, capturing, reporting &

utilization Paper forms entered into tablets weekly by

traveling data clerks using ODK software The data is uploaded to the central database server

(in Lumumba) through VPN. The data is extracted from the ODK database and

exported to a CSV file and transferred to Stata for analysis.

Looking into using a point of care data entry system

MOH daily activity register Monthly reporting done through paper

registers, confirmed by electronic databases

Support supervision tool kit-staff performance , quality of care

6740 women screened 524 of cases diagnosed with Colposcopic-

directed BX 493 LEEP performed 58 micro invasive/invasive cancer

diagnosed and referred 62 HCW trained 6 completed studies

Successful roll out to Suba community Implemented CCSP services to 11 health

facilities Working with DHMT to strengthen

partnership , enhance ownership 22 HCWs trained 1678 women screened 312 with positive exam 3 referred

CIN-HAART: Follow up on outcomes of patients post-LEEP procedure

Assessed safety of LEEPs done by clinical officers, as opposed to physicians

Looked at HIV-1 genital shedding associated with CIN, biopsy and LEEP

Just completed data collection to validate VIA among 1800 HIV-infected women

Looking at novel biomarker for cervical cancer screening

Insufficient funds to support invasive cancer management, improve infrastructure at rural facilities

HCWs lack knowledge of pre cancer treatment protocol and invasive cancer management

Inaccessible treatment for invasive cancer clients

Lack national or regional cancer registry No good data on incidence in HIV-infected

women

Dr Megan Huchko Dr Elizabeth Bukusi Dr Craig Cohen CCSP Team Suba/Kisumu FACES Team MOH partners

THANK YOU