title: Prevalence and incidence of cervical intra-epithelial neoplasia among female sex workers in Korogocho, Kenya.
abstract: METHODS
  Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya.
  
  
  OBJECTIVE
  In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012.
  
  
  METHODS
  Prospective nested cohort study.
  
  
  RESULTS
  Of the 350 women enrolled, the median age was 29 years (range 18-49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infected women were 2.7 times (95%CI 1.7-4.4) more likely to have CIN than non-HIV-1-infected women. Among HIV-1-infected women, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2-5.1) and seven times (95%CI 2.3-23.3) greater than among non-HIV-infected women. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infected women.
  
  
  CONCLUSIONS
  The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.
authors.affiliation: Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
authors.forename: S K
authors.initials: SK
authors.lastname: Njagi
authors.affiliation: Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya.
authors.forename: N R
authors.initials: NR
authors.lastname: Mugo
authors.affiliation: Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières-Luxembourg, Luxembourg.
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.affiliation: Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Kwatampora
authors.affiliation: Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
authors.forename: W
authors.initials: W
authors.lastname: Waweru
authors.affiliation: Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Kimani
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Smith
keywords: CIN; HIV; HPV; cervical cancer