Visual Inspection with Acetic Acid (VIA)

This Sexual and Reproductive Health and Rights (STARS) - Cervical Cancer Screening and Treatment skills module allows nurses, midwives, and clinical officers to become confident and competent in performing visual inspection with acetic acid (VIA) as part of cervical cancer screening and treatment procedures performed in primary health care facilities and mobile units in resource-constrained settings.

Learning Objectives[edit | edit source]

By the end of this module, learners will be able to perform VIA step-by-step; and screen women using VIA tests.

Materials and Equipment[edit | edit source]

Checklist for VIA[edit | edit source]

*The highlighted steps are considered as critical^[1]

Getting Equipment and Instruments Ready[edit | edit source]

1. Keep necessary equipment ready^[1]
2. Check availability of consumables
3. Ensure that the light source is ready to use
4. Arrange instruments and supplies on a high-level disinfected tray or container

Preparation of 5 Percent Dilute Acetic Acid[edit | edit source]

Ingredients and Consumables[edit | edit source]

• Gloves^[2]
• Glacial Acetic Acid
• 5 mL Syringe
• Measuring Cylinder
• Distilled Water
• Glass Bottle
• Marker

Method of Preparation[edit | edit source]

1. Wear gloves
2. Measure 5 ml of glacial acetic acid
3. Pour acetic acid into a measuring cylinder
4. Add 95 ml of distilled water
5. Pour dilute 5% acetic acid into a glass bottle
6. Label the bottle with date of preparation

Storage and use

Precautions

Preparation of 0.5% Chlorine Solution[edit | edit source]

Ingredients and Consumables[edit | edit source]

• Utility Gloves
• Water
• Plastic Bucket
• Bleaching Powder
• Stirrer
• Marker

Method of Preparation[edit | edit source]

1. Wear utility gloves
2. Take 1 litre water in a plastic bucket
3. Measure bleaching powder (approximately 3 teaspoon full)
4. Add a little water to bleaching powder and mix with stirrer to make a thick paste
5. Add this paste to the water in the bucket
6. Stir till a milky white solution is ready
7. Label with date of preparation

Storage and use

Precautions

Steps of VIA[edit | edit source]

1. Check that the woman has emptied her bladder^[1]
2. Help her onto the examination table, help her to be undressed and drape her
3. Wash hands thoroughly with soap and water and dry with clean, dry cloth or air dry them
4. Put one pair of new examination disposable gloves on both hands
5. Inspect external genitalia and check urethral opening for discharge*
6. Select a speculum of appropriate size and lubricate the blades with lubricant jelly or saline
7. Insert the speculum and adjust it so that the entire cervix can be seen
8. Fix the speculum blades in the open position so that the speculum remains in place with the cervix in view
9. Adjust the light source so that you can see the cervix clearly*
10. Examine the cervix for cervicitis, ectropion, nabothian cysts, growth, ulcers or contact bleeding
11. Identify the cervical os, squamocolumnar junction (SCJ) and transformation zone*
12. Soak a clean swab in 3–5% acetic acid and apply it to the cervix*
13. Wait for 1 minute for the acetic acid to be absorbed and any acetowhite change to appear*

The Gynecologic Simulator will be integrated into steps #3, 4, 9, 11-13 of the procedure.

Interpretation of Findings[edit | edit source]

1. Review the Jhpiego Flash Card Set to practise visual inspection of the cervix.
2. Inspect the SCJ carefully

3. Look for any acetowhite area on the cervix:*

• Density
• Margin characteristics
• Location in relation to SCJ or external os
• Number of quadrants involved

1. Identify a Jhphiego Flash Card with an acetowhite lesion suitable for thermal ablation.
2. Use this Flash Card and apply white clay to simulate the lesion on the multiparous clay cervix of the Gynecologic Simulator.

The Gynecologic Simulator will be integrated into steps #1-5 of the procedure.

After Completion of Visual Inspection[edit | edit source]

1. When visual inspection has been completed, use a fresh swab to remove any remaining acetic acid from the cervix and vagina and dispose of the swab
2. Remove the speculum
3. Help the woman to get up from the examination table and sit comfortably

Documentation[edit | edit source]

1. Record the VIA test results and other findings in the woman's case record form*^[1]
2. Draw a map of the cervix and the diseased area (acetowhite changes) on the record using the nomenclature of the International Federation of Cervical Pathology and Colposcopy (2011 IFCPC nomenclature).

The Gynecologic Simulator will be integrated into step #2 of the procedure.

Decontamination and Sterilization[edit | edit source]

1. Dispose of the swabs in appropriate disposal bags^[1]
2. Immerse the speculum in 0.5% chlorine solution
3. Immerse both gloved hands in 0.5% chlorine solution.
4. Remove gloves by turning them inside out
5. Wash hands thoroughly with soap and water and dry with clean, dry cloth or air dry

The Gynecologic Simulator will be integrated into steps #4-5 of the procedure.

Self assessment[edit | edit source]

References[edit | edit source]

Sections of the STARS - Cervical Cancer Screening and Treatment module are copied or adapted from: Training of health staff in VIA, HPV detection test and cryotherapy - Facilitators' guide. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC-BY-NC-SA-3.0 IGO; and WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions. Geneva: World Health Organization; 2019. Licence: CC-BY-NC-SA-3.0 IGO. The World Health Organization (WHO) is not responsible for the content or accuracy of any translation. The original English edition shall be the binding and authentic edition.