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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

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Determining eligibility for ablative treatment after application of acetic acid Ė In the context of VIA screening


The screen-and-treat approach is now a well-accepted algorithm for screening in resource-limited settings. Screen-positive women (either on HPV test or VIA) are offered immediate treatment, without waiting for colposcopic or histopathological verification of the presence or absence of cervical precancer. Such an approach has been demonstrated to be highly effective in randomized trials, it reduces the number of clinic visits by women, improves compliance with treatment, and makes the programme efficient. Cervical precancers can be treated either by ablative techniques (cryotherapy or thermal ablation) or by excisional procedures; both being highly efficacious.

The details of the procedures to treat cervical precancers can be found in the Atlas of Colposcopy: Principles and Practice.

Ablative techniques are simpler, can be performed at primary care level, are less expensive, and have lower complication rates; hence, they are the treatment of choice in screen-and-treat settings. However, not all women will be eligible for treatment by ablation. When VIA is used as a primary screening test, VIA positive women should immediately be assessed for suitability of treatment by ablative techniques, using a set of criteria. Thus, screening and treatment can be completed in a single visit. Women who are not eligible for treatment by ablation need to be treated by excisional procedures.
The criteria for selection of ablative procedure and how to identify these criteria are discussed later.
A magnification device may be used to better identify the features of the cervix and determine eligibility. Several such devices are now available.


Click on the pictures to magnify and display the legends
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