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IHPP June 8, 2007

Situation Analysis of Cervical Cancer Screening in Thailand Progress Report on Quantitative Analysis. IHPP June 8, 2007. An Optimal Policy Strategy for Prevention and Control of Cervical Cancer in Thailand Proposed by International Health Policy Program Funded by World Bank.

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IHPP June 8, 2007

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  1. Situation Analysis of Cervical Cancer Screening in ThailandProgress Report on Quantitative Analysis IHPP June 8, 2007

  2. An Optimal Policy Strategy for Prevention and Control of Cervical Cancer in Thailand Proposed by International Health Policy Program Funded by World Bank

  3. Study objectives • To generate reliable and relevant information to guide health policy choices about prevention and control of cervical cancer in Thailand • To recommend an optimal policy strategy that is cost-effective in the reduction of disease burden of cervical cancer. • To estimate short- and long-terms investments in human resources and infrastructure for appropriate delivery of the newly designed policy strategy for cervical cancer prevention and control.

  4. Research Methodology

  5. Work Package 1 Planned Activities (Cervical Cancer Screening Program Performance)

  6. a Pap smear model demonstration sites: Nakhon Phnom, Arng-Thong; VIA sites: Roi Et, Chiang Mai b Chiang Mai, Lampang, Songkla, Khon Kaen, Bangkok

  7. HPV overview

  8. Brief of cervical cancer screening in Thailand • Cytology screening with pap smear has been available for more than 40 years • In 1997, MOPH began to offer reproductive health services in conjunction with family planning. National policy for cervical cancer proposed that screening be offered to women aged 35–54 years with a Pap test every five years and, in the northeast of Thailand, using visual inspection methods.

  9. Brief of cervical cancer screening in Thailand • 13.5% of the female aged 35-59 years have not been screened for cervical cancer during the last 5 year period. • 36.7% have never been screened for their lifetimes. • Only 49.8% exposed to the screening service at least once within the interval of 5 years. (NSO, 2006) • 37.7% of the female aged 15-44 yearsin 2005 by Reproductive Health Division.

  10. Brief of cervical cancer screening in Thailand • The national program target set by National Health Security Office (NHSO) and MOPH for cervical cancer screening in 2005. • 0.70 million (or 34% of the target group), divided 0.60 million for Pap smear and 0.10 million for VIA are the target group.

  11. Visual inspection with acetic acid Cryotherapy unit VIA positive

  12. Data system: PapRegistry Collect sample PHO Slide reading NCI NHSO Colposcopy or refer

  13. Data System: CPIS PHO VIA DHO Colposcopy or refer NHSO

  14. Situation analysis for coverage and program outcome in selected area • Pap smear : demonstration site of NCI (Nakhon Phanom) • VIA : one oldest site (Roi Et, started 2000) and one other newly implemented site (Chiang Mai, started 2005)

  15. Data Source

  16. PapRegistry • N = 472,694 • Chiangmai = 11,901 • Smear_hcode, province, pid, age, read_hcode, finding, adequacy CPIS • N = 307,442 (18 provinces) • Chiangmai = 28,737 • VIA, cryo, refer, suspca, VIA-pap

  17. PapRegistry

  18. CPIS

  19. Append Pap-VIA

  20. Population coverage

  21. Definition of coverage • Coverage 1 = No. target cases / No. target population • Coverage 2 = No. new cases in 5 y / No. target population • Coverage 3 = No. new cases in 5 y regardless of the screen type / No. target population

  22. Proportion of case % 90.0% 88.1% 88.2%

  23. Screen type and year distribution

  24. Coverage subgroup by time periods(Pap and VIA)

  25. Coverage subgroup by age

  26. Performance %

  27. Screendate distribution (PapReg) Chiang Mai

  28. Screendate distribution (CPIS)

  29. Screening Visits, Chiang Mai No. of visit 99.6% 99.9% 98.7%

  30. Screening Cases No. of case 90.1% 97.3% 79.2%

  31. Cases VS Visits

  32. Classified screen – Append file • screen "via" if via result =1 or 2 • screen "pap" if via result are blank and papdate indicate(via-pap) • 6,147/28,731 = 21.4% conducted the via-pap group. • 79.76% not completely the SCJ to determine

  33. Population Coverage

  34. Coverage subgroup by age

  35. Coverage subgroup by geo. location

  36. Coverage subgroup by geo. location

  37. Coverage by denominator

  38. Coverage by denominator: Chiang Daw hospital2006

  39. Trend over time % coverage

  40. Roi Et, VIA started 2000 Case Coverage in % 10.41 11.06 9.06 8.39 6.50 3.45 VIA started NHSO involved

  41. Coverage subgroup by %

  42. Facility Performance (Pap smear) 3.35 3.40 36.87 56.11 1.48 1.37 42.32 54.45 2005 2006

  43. Facility Performance (VIA) 6.81 15.91 92.92 2005 84.09 2006

  44. Program outcome

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