A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria.
OBJECTIVE
Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.


METHODS
In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.


RESULTS
Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.


CONCLUSIONS
In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.
Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria. ajenifujako@yahoo.com
Kayode Olusegun
KO
Ajenifuja
Julia C
JC
Gage
Akinfolarin C
AC
Adepiti
Nicolas
N
Wentzensen
Claire
C
Eklund
Mary
M
Reilly
Martha
M
Hutchinson
Robert D
RD
Burk
Mark
M
Schiffman
D019342:Acetic Acid; D000230:Adenocarcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D009549:Nigeria / Q000453:epidemiology; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012424:Rural Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology
D019342:Acetic Acid