Cervical Screening by Visual Inspection with Acetic Acid (VIA) is Well Accepted by Women - Results from a Community-based Study in Rural India

Objective: Among the low cost alternative screening tests Visual Inspection after Acetic Acid Application (VIA)has been found to be most promising. The objective of the present study was to evaluate the safety and acceptabilityof VIA done by health workers among rural Indian women. We also evaluated the level of women’s satisfaction withthe screening program.
Methods:Women residing in a defined geographic area were offered cervical screeningusing VIA by trained health workers. Women testing positive were colposcoped by a medical officer at the samesitting. Based on the feedback from a few focus group discussions a structured questionnaire was designed to interviewthe women after screening. A total of 498 women were selected randomly from the screened women for interview bya social worker. Besides enquiring about any discomfort they faced during or within seven days after screening, thewomen were also asked to indicate their level of satisfaction with the service. Their opinions to improve the quality ofservice were also sought.
Results: Most women reported no pain or only slight discomfort during screening (94.2%).The most common complaint after screening was vaginal discharge (12%). A burning sensation in the vagina wasexperienced by some of the women (5.8%). These complaints were mild and short-lasting in majority of cases. Mostof the women were satisfied with the screening service (94.6% selected the top three of a six-point response scale) and97% said they would recommend the test to others. The most common reasons for dissatisfaction with screeningwere discomfort during or after screening, long waiting time and failure to get treatment for other medical problems.
Conclusion: VIA by trained health workers followed by colposcopy at the same sitting is an acceptable screeningalgorithm for Indian women. A VIA based screening program has to be integrated to the existing primary healthcare facility in developing countries.