title: Evaluation of Cervical Cancer Screening Programs in Côte d'Ivoire, Guyana, and Tanzania: Effect of HIV Status.
abstract: BACKGROUND
  HIV infection increases a woman's risk for cervical cancer, and cervical cancer incidence and mortality rates are higher in countries with high HIV prevalence and limited resources for screening. Visual inspection with acetic acid (VIA) allows screening and treatment of cervical lesions in a single-visit approach (SVA), but data on its performance in HIV-infected women are limited. This study's objective was to examine cervical cancer screening using VIA/SVA in programs serving HIV-infected women.
  
  
  METHODS
  A VIA/SVA program with cryotherapy for VIA-positive lesions was implemented in Côte d'Ivoire, Guyana, and Tanzania from 2009 to 2012. The effect of HIV status on VIA positivity and on presence of cryotherapy-eligible lesions was examined using a cross-sectional study design, with Chi-square tests for comparisons and constructed multivariate logistic regression models. A P-value of < 0.05 was significant.
  
  
  RESULTS
  VIA was performed on 34,921 women, 10% (3,580) were VIA positive; 2,508 (85%) eligible women received cryotherapy during the same visit; only 234 (52%) of those who postponed returned for treatment; 622 (17%) VIA-positive women had lesions too large to be treated with cryotherapy and were referred for excisional treatment. In multivariate analysis-controlling for HIV status, location of the screening clinic, facility location, facility type, and country-compared to HIV-uninfected/unknown women, HIV-infected women had higher odds of being VIA positive (OR 1.95, 95% CI 1.76, 2.16, P<0.0001) and of having large lesions requiring referral (OR 1.93, 95% CI 1.49, 2.51, P< 0.0001). Minor treatment complications occurred in 19 of 3,032 (0.63%) women; none required further intervention.
  
  
  CONCLUSIONS
  This study found that compared to HIV-uninfected/unknown women, HIV-infected women had nearly twice the odds of being VIA-positive and to require referral for large lesions. SVA was safe and resulted in significant reductions in loss to follow-up. There is increased need for excisional treatment in countries with high HIV prevalence.
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.
authors.forename: Jean
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Megan
authors.initials: M
authors.lastname: Wysong
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Deb
authors.initials: D
authors.lastname: Estep
authors.affiliation: Jhpiego/Tanzania, an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania.
authors.forename: Giulia
authors.initials: G
authors.lastname: Besana
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kibwana
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Varallo
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America.
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Enriquito
authors.initials: E
authors.lastname: Lu
mesh_terms: D007560:Cote d'Ivoire / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006172:Guyana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy / Q000821:virology*