Background and Context: Screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy is recommended by WHO as a method for the prevention of cervical cancer in low resource settings. Pap tests have not been successful in lowering the incidence of cervical cancer in Fiji, which remains high at 38/100,000 women and although the HPV vaccine is now available, the impact on incidence or mortality will not be seen for many years.
Aim: To build the capacity for cervical cancer prevention in Fiji.
Strategy/Tactics: We utilised a participatory approach to developing a sustainable cervical cancer screening project. From 2011-2014, an Australian government funded project featured a three stage strategy with Fijian partners and project staff integral to the success of each stage.
Programme/Policy Process: Firstly the feasibility of using VIA and cryotherapy in rural and urban Fiji was determined, with equipment and consumables sourced locally where possible. Fijian nurses and doctors were trained in VIA screening and treating women with non-referable cervical lesions with cryotherapy. Awareness and recruitment activities were provided by a local NGO partner. 2000 women aged 30-50 years were screened in the first year.
In the second stage the results of the feasibility study were presented to stakeholders in Fiji and a consensus statement made supporting inclusion of VIA in the National Cervical Screening Program. A customised VIA and Cryotherapy training package was developed and piloted in a National training course in 2013, co-facilitated by Fijian and Australian project nurses.
In the project's final stage VIA training was provided by Fijian nurses to all health divisions with plans to extend VIA screening coverage across all the Fiji Islands.
Outcomes/What was learned: Nurses can provide effective VIA screening and cryotherapy treatment in a low-resource Pacific Island setting and therefore build the capacity for cervical cancer prevention.