1. May Maloba, CCSP Coordinator August 10, 2012

2.  FACES CCSP overview  Program emphasis  Screening protocols  M & E  Achievements  Challenges

3.  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

4.  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

5. Enrollment: cervical cancer education part of HIV education talks Triage desk: CCHA’s aware of eligibility criteria, (>23 yrs, not pregnant) Sticker system flag files Clinicians: also aware of eligibility criteria, sticker system, when finish seeing patient,

6. V.I.A. Colposcopy Biopsy LEEP +- V.I.A. in 3 yrs Colposcopy in 1 yr CIN1 CIN2+ Colposcopy in 6 mos - CIN1/Negative

7. VIA/VILI Colposcopy Biopsy LEEP V.I.A. in 3 yrs Colposcopy in 1 yr CIN1 CIN2+ Colposcopy in 6 mos - CIN1/Negative

8. VIA/VILI LEEP - Rescreen in 3 yrs Cryotherapy Non cryo candidate + Includes all non-pregnant women over 23, regardless of HIV status

9.  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

10.  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

11.  MOH daily activity register  Monthly reporting done through paper registers, confirmed by electronic databases  Support supervision tool kit-staff performance, quality of care

12.  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

13.  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

14.  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

15.  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

16.  Dr Megan Huchko  Dr Elizabeth Bukusi  Dr Craig Cohen  CCSP Team Suba/Kisumu  FACES Team  MOH partners THANK YOU