Abstract:

In Brazil, the high prevalence of Sexually Transmitted Diseases (STDs) led government to launch massive campaigns to enhance prevention and treatment seeking for STDs. As a consequence, the health system was overloaded with a great demand for sexual and reproductive health consultation. In addition, few health units’ professionals were effectively trained to identify, to diagnose and treat these diseases. In fact, since the launching of the National Control Programme of STDs/SIDA by Brazilian Ministry of Health, primary care health units were in need of training for health professionals to adequately address the syndromic approach at primary health units’ level. Among different strategies already used in training of doctors and nurses are presence courses. In case the family health teams are located in municipalities far from main centres, continuing education strategies become less effective due to logistic difficulties and need to travel long distances to get training. Currently, besides lack of training, Brazilian health professionals also lack proper magnifying equipment to perform a detailed visual inspection in order to identify clinical and sub-clinical genital lesions, mostly at initial stages. On the other hand, over the last few years, primary health units throughout the country have received investments in computers and high speed internet connections. Therefore, the incorporation of distance training to family health units became feasible. One strategy already tested was the Digital Cervicography (DC) training course to improve early and effective identification of STDs genital lesions with the advantages of low cost, easy access and interactivity possibilities. The DC technique involves use of photographic equipment to produce images of cervix or genitals to allow diagnosis. The 12 hour training was divided into three main parts: 1) attendance of a 4 hour lecture on DC technique and criteria to diagnose images, a pre-test with images to diagnose; 2) health professional receives regularly images of cervix and genitals to diagnose; 3) post-test with images to diagnose. Material was sent through e-mail. There is support during the course from a tutor that would help clarify doubts about images and/or theoretical issues. This course structure allowed health professionals to receive training while working at health units. More than two hundred health professionals and undergraduate medical and nursing students from Portugal and Brazil received this training. To this date, the mean of correct identification of cervical cancer precursor’s lesions and other STDs from trained health professionals is as high as 87% in tests with forty images presented after training. In fact, health professionals trained through distance education obtained better results in test sensibility with DC (99,1%) when compared to cytology (22,5%) and colposcopy (81,6%). This training initiative is being expanded to primary health care professionals of Fortaleza, Brazil municipality.

Keywords:

Digital cervicography, distance education.