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PLoS One. 2019 Jun 19;14(6):e0218559. doi: 10.1371/journal.pone.0218559. eCollection 2019.

Performance of careHPV, hybrid capture 2 and visual inspection with acetic acid for detection of high-grade cervical lesion in Tanzania: A cross-sectional study.

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Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Danish Cancer Society Research Center, Unit of Virus, Lifestyle and Genes, Copenhagen, Denmark.
Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania.
Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark.
University of Southern Denmark, Odense, Denmark.
Department of Virologi, Tuebingen University Hospital, Tuebingen, Germany.
Department of Pathology, Vejle Hospital, Vejle, Denmark.



To examine the test performance of careHPV, Hybrid Capture2 (HC2) and visual inspection with acetic acid (VIA) for detection of cytologically diagnosed high-grade cervical lesions or cancer (HSIL+).


Cross-sectional study.


Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Center (KCMC), Tanzania.


Women attending routine cervical cancer screening.


We enrolled 4080 women (25-60 years) in the study. The women were interviewed on lifestyle habits, and tested for HIV. A cervical specimen for careHPV testing (performed at ORCI and KCMC), and a liquid-based cytology sample for HPV DNA detection using HC2 (performed at Tuebingen University Hospital, Germany) and for cytology assessment (performed at Vejle Hospital, Denmark) were obtained at a gynecological examination. Subsequently, VIA was performed. With cytology as gold standard, the sensitivity and specificity of careHPV, HC2, and VIA for detection of HSIL+ were calculated.


Altogether, 23.6% had a positive careHPV test, 19.1% had positive HC2 test, and 6.3% had a positive VIA test. The sensitivity/specificity was 88.9%/78.9% for careHPV and 91.1%/83.7%, for HC2. VIA showed a low sensitivity of 31.1% but a high specificity (94.6%) for detection of HSIL+. The sensitivity of careHPV, HC2 and VIA was higher among younger women, and among HIV positive women. VIA triage of careHPV positive women improved specificity, but sensitivity dropped to 27%.


Our results confirm the low sensitivity of VIA for detection of HSIL+ and further document that careHPV test is promising as a primary screening method for cervical-cancer prevention in low-resource regions. A suitable triage test has to be identified.

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: SK has received speaker’s fee from Sanofi Pasteur MSD and Merck, scientific advisory board fee from Merck, and research grant through her institution from Merck. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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