Comparison of Conventional Cervical Cytology Versus Visual Inspection With Acetic Acid Among Human Immunodeficiency Virus–Infected Women in Western Kenya

Abstract

Objective To determine the accuracy of visual inspection with Acetic Acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia (CIN)/cancer among HIV-infected women. Materials and Methods 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy and biopsy. VIA and Pap smears were done by nurses while colposcopy and biopsy were done by a physician. Receiver Operating Characteristic (ROC) 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, CI=47.0–63.5%); Pap smear showed atypical squamous cells of undetermined significance (ASCUS) or worse in 43.7% (59/135, CI=35.2–52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the abnormal Pap smears, 3% (2/59) had ASCUS, 7% (4/59) had ASC-high grade, 60% (35/59) had low-grade squamous intraepithelial lesions (SIL), 29% (17/59) had high grade SIL, and 2% (1/59) was suspicious for cervical cancer. Using cervical intraepithelial neoplasia (CIN) 2 or higher disease on biopsy as an end point, VIA has a sensitivity of 69.6% (CI=55.1–81.0%), specificity of 51.0% (CI=41.5–60.4%), PPV of 38.6% (CI=28.8–49.3%) and NPV of 79.1% (CI=67.8–87.2%). For conventional Pap smear, sensitivity was 52.5% (CI=42.1–71.5%), specificity 66.3% (CI=52.0–71.2%), PPV 39.7% (CI=27.6–51.8%), and NPV 76.8% (CI=67.0–85.6%). Conclusion VIA is comparable to Pap smear and acceptable for screening HIV-infected women in resource limited settings such as Western Kenya.

Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-Infected Women in Lusaka, Zambia

“…8–10 The specificity point estimate of DC for CIN2+ that we report (58%) lies near the lower end of the range (51% – 83%) reported for unaided VIA in these studies. 8–10 The specificity point estimate of cytology for CIN2+ that we report (58%) is slightly lower but comparable to that of Mabeya et al (66%), 9 while both are substantially lower than that reported by Sahasrabuddhe et al (83%). 8 Our lower specificity of cytology could be because our histopathology gold standard was based solely on punch biopsy specimens.…”

Sociodemographic determinants of abnormal cervical cytology among HIV positive women in Nnewi, Nigeria

“…The prevalence of 28.2% as found in this study is high but comparable to 27% reported in UK by Hotonu et al (2010) and 31.3% in Maiduguri, Northern Nigeria by Chama et al (2005). It is however lower than 68.3 and 43.7% prevalence rates reported in Jos, Nigeria by Agaba et al (2009) and in Kenya by Mabeya et al (2012). A lower rate of 12.6% was reported in Enugu by Dim et al (2011).…”

HIV, Tuberculosis, and Noncommunicable Diseases

“…Multiple screening methods have demonstrated accuracy in LMICs, 91,100 with the ability to incorporate mobile technologies 101,102 and well-trained non-physician clinicians to extend services. 96,102,103 Likewise, when precancerous lesions are identified, multiple treatment options demonstrate excellent efficacy in LMICs.…”