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


RESULTS
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).


CONCLUSIONS
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.
University of California, San Francisco, 50 Beale Street (Suite 1200), San Francisco, CA 94105, United States of America (USA).
Megan J
MJ
Huchko
University of California, San Francisco, 50 Beale Street (Suite 1200), San Francisco, CA 94105, United States of America (USA).
Jennifer
J
Sneden
University of California, Berkeley, USA .
Hannah H
HH
Leslie
Kenya Medical Research Institute, Nairobi, Kenya .
Naila
N
Abdulrahim
Kenya Medical Research Institute, Nairobi, Kenya .
May
M
Maloba
Kenya Medical Research Institute, Nairobi, Kenya .
Elizabeth
E
Bukusi
University of California, San Francisco, 50 Beale Street (Suite 1200), San Francisco, CA 94105, United States of America (USA).
Craig R
CR
Cohen
D019342:Acetic Acid; D000328:Adult; D017677:Age Distribution; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage; D007454:Iodides; D007630:Kenya; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000379:methods*; D055815:Young Adult
D007202:Indicators and Reagents; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution