Lessons Learned From 7 Years of Implementing Cervical Cancer Screening and Treatment in Equatorial Guinea

Abstract

Purpose: This study aimed to assess the results of the Cervical Cancer Screening and Treatment (CCST) project in Equatorial Guinea and the reach of facility-based and community outreach service delivery strategies.

Materials and methods: The CCST project implemented the single-visit, screen-and-treat approach, using visual inspection with acetic acid (VIA) and treatment with cold coagulation (and referral for further evaluation where needed) for women age 20-60 years. The project deployed two service delivery strategies: in health facilities and through community outreach. The project conducted cascaded training, routine supervision for quality improvement, communication campaigns, and community mobilization efforts.

Results: Between 2017 and 2023, 26,998 women were screened. The two strategies reached almost equal numbers of women. Community outreach reached more women in the country's mainland. It also reached significantly more married women, women with age at first sexual intercourse at or before 16 years, and those who were puerperal, postmenopausal, and multiparous than facility-based screening. VIA positivity rate was 2.6% overall, with higher rates among younger women. Fifty-five percent of VIA-positive women were treated with cold coagulation, 10% were referred for further evaluation, and 18% received no treatment.

Conclusion: To our knowledge, this first-ever effort in CCST in Equatorial Guinea has shown that both facility-based and community outreach are effective in implementing the single-visit, screen-and-treat approach and underscores the need to continue and further expand the effort, strengthen the quality of services delivered and data capture, and increasingly transfer the capacity to implement facility-based screening and community outreach to the Ministry of Health.