The callback rate was another area that was affected by our decision
to exclude the local doctors. Although the callback rate of 84.3% is good
in these rural settings , we are confident that, by maximizing
the enthusiasm of the CLs and promoters together with educating and
then involving the local doctors in themanagement phase of the screening
campaigns, the callback rate will be improved significantly. Callback
for positive management we feel should always be conducted
first by the community and then if the community fails to convince
the woman to return for evaluation and management, the next contact
should come from the local doctors.
In the future, prior to the screening event, a name-list of the communitywomenwho
are eligible should be in hand, if onewants to properly
evaluate the effectiveness of the model. As our census evaluation demonstrated
this appears to be easy information to come-by since the promoters
demonstrated a “good to excellent” correlation with our door to
door census survey. This information can also be used by organizers to
decide when an appropriate time would be to repeat the screening
event for a particular group of communities. Coveragewill also be easier
to evaluate if in the future large screening campaigns the organizer can
coordinate with the central laboratory and keep detailed records for
who has participated in the screening programs when they are offered.
In most settings, establishing a newmodel is always easier if nothing
currently exists. If an old system, even one that is labor intensive and
resource expensive, needs to be dismantled to build a new, it often
takes years, a generation of caregivers, and there are major obstacles
created by those benefitting from the old system. Current cervical cancer
screening systems used in China are mostly cytology based. This is
problematic since cytology skills are not widely available and the needed
infrastructure is not in place to allow a cytology based system to
serve the vast rural populations in China. In addition a cytology system
is insensitive ,and due to the labor intensive interpretation of the
slides, and the needed callback infrastructure, it is slow, and difficult
to apply to large populations. CareHPV was developed to be a low
cost, low tech HPV test to be used to reach the medically underserved
of the world .However, application has been slow with many
delays of actual implementation although multiple pilots still continue.
It is also not high throughput and the final per patient cost is still
unknown. Unaided visual inspection with acetic acid (VIA), is often
touted as the life-saving “see and treat” screening method for many
medically underserved regions of the world. It does lend itself to see
and treat, but it is also slow, insensitive, and misses at least 50% of the
high grade lesions . It has been shown to reduce cancers, with a
labor intensive repeated door to door effort, and clearly requires a
“best we can do under the circumstances” mentality
The callback rate was another area that was affected by our decision
to exclude the local doctors. Although the callback rate of 84.3% is good
in these rural settings , we are confident that, by maximizing
the enthusiasm of the CLs and promoters together with educating and
then involving the local doctors in themanagement phase of the screening
campaigns, the callback rate will be improved significantly. Callback
for positive management we feel should always be conducted
first by the community and then if the community fails to convince
the woman to return for evaluation and management, the next contact
should come from the local doctors.
In the future, prior to the screening event, a name-list of the communitywomenwho
are eligible should be in hand, if onewants to properly
evaluate the effectiveness of the model. As our census evaluation demonstrated
this appears to be easy information to come-by since the promoters
demonstrated a “good to excellent” correlation with our door to
door census survey. This information can also be used by organizers to
decide when an appropriate time would be to repeat the screening
event for a particular group of communities. Coveragewill also be easier
to evaluate if in the future large screening campaigns the organizer can
coordinate with the central laboratory and keep detailed records for
who has participated in the screening programs when they are offered.
In most settings, establishing a newmodel is always easier if nothing
currently exists. If an old system, even one that is labor intensive and
resource expensive, needs to be dismantled to build a new, it often
takes years, a generation of caregivers, and there are major obstacles
created by those benefitting from the old system. Current cervical cancer
screening systems used in China are mostly cytology based. This is
problematic since cytology skills are not widely available and the needed
infrastructure is not in place to allow a cytology based system to
serve the vast rural populations in China. In addition a cytology system
is insensitive ,and due to the labor intensive interpretation of the
slides, and the needed callback infrastructure, it is slow, and difficult
to apply to large populations. CareHPV was developed to be a low
cost, low tech HPV test to be used to reach the medically underserved
of the world .However, application has been slow with many
delays of actual implementation although multiple pilots still continue.
It is also not high throughput and the final per patient cost is still
unknown. Unaided visual inspection with acetic acid (VIA), is often
touted as the life-saving “see and treat” screening method for many
medically underserved regions of the world. It does lend itself to see
and treat, but it is also slow, insensitive, and misses at least 50% of the
high grade lesions . It has been shown to reduce cancers, with a
labor intensive repeated door to door effort, and clearly requires a
“best we can do under the circumstances” mentality
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