Bolivia, Colombia, Nicaragua and Peru, with plans for
expanding the work to other countries in the region. A similar
regional training centre is also being developed by the
Uganda Cancer Institute (UCI), in collaboration with PATH, to
develop master trainers for national screening programmes
in Africa. PATH and UCI have worked with the WHO African
Regional Office (AFRO) to create an English-language
curriculum for VIA and cryotherapy building on the materials
from Latin America.
Challenges and potential solutions
Even though VIA is currently used in multiple countries
(Figure 1), it is usually on a limited basis, and there is still a
need to expand or introduce the capacity in many countries.
One approach that could help to expand this capacity is by
further development of training excellence centres (TEC) in
several regions, such as Francophone Africa and Asia, to train
more master trainers who can then cascade the training to
health workers throughout government health facilities.
Another challenge for expanding the use of VIA is the need
for follow-up, monitoring and evaluation of providers using it,
since VIA is a subjective test and has no feasible mechanism
for routinely creating a permanent record of what the
evaluator observed during the exam. While digital cameras
have been used in a few countries and can be helpful for
training or periodic monitoring, they are not affordable or
sustainable for routine use in most low-income countries.
One possible way to secure good quality of services is to visit
providers periodically and make a review of a standard set of
case photos to measure their skills in identifying cancer and
precancer. Another option is to provide refreshment of skills
using an Internet website, where the provider accesses the
website periodically and reviews a standard set of case
photos; a score is obtained at the end, and those who are
under the optimal score should receive a face-to-face followup. A web-based tool in Spanish was recently developed
in
DISEASE-SPECIFIC CANCER CONTROL
86 CANCER CONTROL 2014
Figure 1: Global progress in Visual Inspection (VIA) for cervical cancer screening18