title: Comparison of conventional cervical cytology versus visual inspection with acetic acid among human immunodeficiency virus-infected women in Western Kenya.
abstract: OBJECTIVE
  This study aimed to determine the accuracy of visual inspection with acetic acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia/cancer among human immunodeficiency virus (HIV)-infected women.
  
  
  METHODS
  A total of 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy, and biopsy. Both VIA and Pap smears were done by nurses, whereas colposcopy and biopsy were done by a physician. Receiver operating characteristic analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
  
  
  RESULTS
  Among the study participants: VIA was abnormal in 55.3% (83/150, 95% confidence interval [CI] = 47.0%-63.5%); Pap smear showed atypical squamous cells of undetermined significance or worse in 43.7% (59/135, 95% CI = 35.2%-52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the abnormal Pap smears, 3% (2/59) had atypical squamous cells of undetermined significance, 7% (4/59) had high-grade atypical squamous cells, 60% (35/59) had low-grade squamous intraepithelial lesions, 29% (17/59) had high-grade squamous intraepithelial lesions, and 2% (1/59) was suspicious for cervical cancer. Using cervical intraepithelial neoplasia 2 or higher disease on biopsy as an end point, VIA has a sensitivity of 69.6% (95% CI = 55.1%-81.0%), specificity of 51.0% (95% CI = 41.5%-60.4%), PPV of 38.6% (95% CI = 28.8%-49.3%), and NPV of 79.1% (95% CI = 67.8%-87.2%). For conventional Pap smear, sensitivity was 52.5% (95% CI = 42.1%-71.5%), specificity was 66.3% (95% CI = 52.0%-71.2%), PPV was 39.7% (95% CI = 27.6%-51.8%), and NPV was 76.8% (95% CI = 67.0%-85.6%).
  
  
  CONCLUSIONS
  Visual inspection with acetic acid is comparable to Pap smear and acceptable for screening HIV-infected women in resource-limited settings such as Western Kenya.
authors: United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Moi University School of Medicine, Eldoret, Kenya.
authors: Hillary
authors: H
authors: Mabeya
authors: Kareem
authors: K
authors: Khozaim
authors: Tao
authors: T
authors: Liu
authors: Omenge
authors: O
authors: Orango
authors: David
authors: D
authors: Chumba
authors: Latha
authors: L
authors: Pisharodi
authors: Jane
authors: J
authors: Carter
authors: Susan
authors: S
authors: Cu-Uvin
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001706:Biopsy / Q000379:methods; D003127:Colposcopy / Q000379:methods; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D019342:Acetic Acid