Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

Nestory Masalu, Patrizia Serra, Dino Amadori, Jackson Kahima, Charles Majinge, Joyce Rwehabura, Oriana Nanni, Sara Bravaccini, Maurizio Puccetti, Rosario Tumino, Lauro Bucchi

To report the results of a pilot study for a service for cervical cancer screening and diagnosis in north-western Tanzania. The pilot study was launched in 2012 after a community-level information campaign. Women aged 15-64 years were encouraged to attend the district health centres. Attendees were offered a conventional Pap smear and a visual inspection of the cervix with acetic acid (VIA). The first 2500 women were evaluated. A total of 164 women (detection rate 70.0/1000) were diagnosed with high-grade cervical intraepithelial neoplasia and invasive cervical cancer. The performance of VIA was comparable to that of Pap smear. The district of residence, a history of untreated sexually transmitted disease, an HIV-negative status (inverse association), and parity were independently associated with the detected prevalence of disease. The probability of invasive versus preinvasive disease was lower in HIV-positive women and in women practicing breast self-examination. The diagnostic procedure had an acceptable level of quality. Factors associated with the detected prevalence of disease will allow for a more targeted promotion of the service. Cervical screening should be coordinated with sexually transmitted disease and HIV infection control activities.