ArticleBMJ open2019
The impact of decentralising colposcopy services from tertiary-level to primary-level care in inner-city Johannesburg, South Africa: a before and after study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Pooled it
- Access to cervical cancer care in sub-Saharan Africa: a narrative review of barriers and opportunities.Frontiers in public health · 2026Review
- Integrating pocket colposcope and telecolposcopy into VIA-based screening at primary healthcare centers for cervical cancer prevention in LMICs.Frontiers in oncology · 2026Review
- Challenges and facilitators in pathways to cancer diagnosis in Southern Africa: a qualitative study.BMJ open · 2025Article
- High burden of abnormal cervical smears in South African primary health care: health programmes implications.Health promotion international · 2025Article
- Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers' training and practices.BMC health services research · 2024Article
- Automated analysis of digital medical images in cervical cancer screening: A systematic review.medRxiv : the preprint server for health sciences · 2024Article
- Mobile colposcopy by trained nurses in a cervical cancer screening programme at Battor, Ghana.Ghana medical journal · 2022Article
- Integrating Cervical Cancer Screening Into Safer Conception Services to Improve Women's Health Outcomes: A Pilot Study at a Primary Care Clinic in South Africa.Sexually transmitted diseases · 2019Article
- Colposcopy in the Primary Health Care: A Scoping Review.Journal of primary care & community healthArticle
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess whether decentralising colposcopy services to a primary care facility in inner-city Johannesburg, South Africa raises access to colposcopy.
designBefore-after study comparing 2 years before and 2 years after decentralisation, using clinical records and laboratory data on cervical cytology and histology. PRIMARY OUTCOME: The proportion of all women attending Hillbrow Community Health Centre (HCHC) with an abnormal Papanikolaou (Pap) smear who had a colposcopy post-decentralisation.
settingCharlotte Maxeke Johannesburg Academic Hospital (CMJAH) has provided colposcopy services for several decades. HCHC, located about 3 km away, began colposcopy services in 2014.
participantsWomen, aged above 18 years, who had a colposcopy for diagnosis and treatment of precancerous cervical lesions following a Pap smear, from 2012 to 2016 at CMJAH or HCHC.
resultsPre-decentralisation at CMJAH, 910 women had colposcopy (2012-2014). Post-decentralisation (2014-2016), 721 had colposcopy at CMJAH and 399 at HCHC, the decentralised facility. The number who had a Pap smear at HCHC and then a colposcopy rose threefold post-decentralisation (114 vs 350). Post-decentralisation, 43 women at HCHC were referred to CMJAH for colposcopy, compared with 114 pre-decentralisation. Post-decentralisation, 47.3% of women at CMJAH waited >6 months for colposcopy, while 35.5% did at HCHC (p<0.001). Across all three groups, 26.9%-30.3% of women had cervical intraepithelial neoplasia III lesions or carcinoma on colposcopy. The proportion of invalid specimens was similar at CMJAH and HCHC (1.8%-2.8%). Of 401 women who had an abnormal Pap smear at HCHC post-decentralisation, 267 had colposcopy (66.6%).
conclusionDecentralisation can decrease the time to colposcopy and reduce the workload of tertiary hospitals. Overall, more women accessed services. Colposcopy coverage at HCHC is higher than other sites, but could be further improved. Decentralisation did not appear to undermine the quality of services and this model could be extended to similar settings in South Africa and elsewhere.
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