Abstract #368  -  Cervical cancer screening in a family care model clinic at botswana-baylor coe
Authors:   Presenting Author:   Tafireyi Marukutira -
Additional Authors:  Ms Rachel Seleke, Mr/s Gadzikanani Monyatsi,
Aim: A family model approach in a paediatric HIV (Human Immunodeficiency virus) care is designed to meet the HIV health care needs of all family and household members of an HIV infected children: a one-stop shop. The family model approach strives to integrate the care of the HIV infected child and family members in a single clinic setting. Cervical cancer has the second highest prevalence (after Breast cancer followed by Kaposi sarcoma) in women in Botswana (WHO, 2007). There is an association between HIV and Human Papiloma Virus (HPV), the virus that is associated with cervical cancer. HPV cervical infection results in cervical morphological lesions ranging from normal to pre-cancerous lesions such as CIN (Cervical intra-epithelial neoplasm) 1-3. Cervical screening through the use of pap smears can pick up these early lesions and if managed early can prevent the development of cancer of the cervix. Female patients in the Family Model Clinic (FMC) at the Botswana-Baylor Childrens Clinical Centre of Excellence require Pap smear screening, as do the teenagers who have now become sexually active. According to Musa-Aisien et al, a combined clinic offers efficiency, appropriateness, cost effectiveness and potential to promote better treatment outcomes through enhanced intra-family support (Int. Conf AIDS. 2004). WHO reports prevalence of HPV prevalence as follows: Southern Africa World No. tested HPV prevalence % (95%CI) No. tested HPV prevalence % (95%CI) Normal cytology 1269 15.5 (13.6-17.6) 157 879 10.09(8-10.1) Low-grade lesions (LSIL, CIN-1) - - 8 640 71.6 (70.6-72.5) High-grade lesions (CIN-2, CIN-3, CIS or HSIL) 129 88.4 (81.5-93.3) 7 094 84.9 (84.1-85.7) Cervical Cancer 308 93.8 (90.5-96.2) 14 595 87.2 (86.7-87.8)
Method / Issue: A medical record review of all female patients in the FMC was carried out to check the status of baseline Pap smear screening and the results of the screening. From this data, the prevalence of CIN 1-3 and cervical cancer in the cohort was calculated.
Results / Comments: As of February 2009, the FMC has a total of 281 adult patients (age range 19-80yrs). Of these 243 (86.5%) are females. The Pap smear coverage rate was 53.9% (131) and the results are as follows: Number Percentage Normal cytology 72 29.6 Low-grade lesions (LSIL, CIN-1) 37 15.2 High-grade lesions (CIN-2, CIN-3, CIS or HSIL) 16 6.6 Cervical Cancer 4 1.6 No results 113 46.5 Total 243 100 29.6% had a normal pap smear while 21.8% had an abnormal Pap smear result while 4 women had cancer of the cervix.
Discussion: There is need to have all women screened for cervical cancer, including the young, sexually active adults transitioning out of paediatric care. Technical laboratory aspects need to be put in place so that the turn around time and availability of accurate Pap smear results is improved. The FMC is a relatively new intervention at Botswana-Baylor Children�s Clinical Centre of Excellence hence there is room to improve on the Pap smear coverage rate. These results also demonstrate the importance of a one stop shop in the family model concept.
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