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Bull World Health Organ. 2014 Mar 1;92(3):195-203. doi: 10.2471/BLT.13.122051. Epub 2014 Jan 15.

A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya.

Author information

1
University of California, San Francisco, 50 Beale Street (Suite 1200), San Francisco, CA 94105, United States of America (USA).
2
University of California, Berkeley, USA .
3
Kenya Medical Research Institute, Nairobi, Kenya .

Abstract

in English, Arabic, Chinese, French, Russian, Spanish

OBJECTIVE:

To determine the optimal strategy for cervical cancer screening in women with human immunodeficiency virus (HIV) infection by comparing two strategies: visual inspection of the cervix with acetic acid (VIA) and VIA followed immediately by visual inspection with Lugol's iodine (VIA/VILI) in women with a positive VIA result.

METHODS:

Data from a cervical cancer screening programme embedded in two HIV clinic sites in western Kenya were evaluated. Women at a central site underwent VIA, while women at a peripheral site underwent VIA/VILI. All women positive for cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) on VIA and/or VILI had a confirmatory colposcopy, with a biopsy if necessary. Overall test positivity, positive predictive value (PPV) and the CIN 2+ detection rate were calculated for the two screening methods, with biopsy being the gold standard.

FINDINGS:

Between October 2007 and October 2010, 2338 women were screened with VIA and 1124 with VIA/VILI. In the VIA group, 26.4% of the women tested positive for CIN 2+; in the VIA/VILI group, 21.7% tested positive (P < 0.01). Histologically confirmed CIN 2+ was detected in 8.9% and 7.8% (P = 0.27) of women in the VIA and VIA/VILI groups, respectively. The PPV of VIA for biopsy-confirmed CIN 2+ in a single round of screening was 35.2%, compared with 38.2% for VIA/VILI (P = 0.41).

CONCLUSION:

The absence of any differences between VIA and VIA/VILI in detection rates or PPV for CIN 2+ suggests that VIA, an easy testing procedure, can be used alone as a cervical cancer screening strategy in low-income settings.

PMID:
24700979
PMCID:
PMC3949589
DOI:
10.2471/BLT.13.122051
[Indexed for MEDLINE]
Free PMC Article
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