Factors associated with a cervical high‐grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women

Abstract

Objectives Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high‐grade lesions on cytology. Methods We conducted a large cross‐sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio‐demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs). Results The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34–5.17) or to high‐risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37–2.85). HrHPV was by far the strongest predictor of high‐grade cytology (OR = 110.1; 95% CI: 50.4–240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78–2.08). After adjustment for HrHPV, HIV and age, the risk of high‐grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity. Conclusions Infection with HrHPV is a major risk factor for high‐grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.

The association between human papillomavirus and cervical high‐grade cytology among HIV‐positive and HIV‐negative Tanzanian women: A cross‐sectional study

“…16 Women who were HR-HPV positive had an almost 100-fold in- 16 and it is suggested that because of an altered immune system, older women are more likely to develop precancerous lesions and cancer. 17 We found an overall HGC prevalence of 3.6%, which is in line with a previous Tanzanian study conducted among a similar study population reporting an HGC prevalence of 3.7%. 17 However, our HGC prevalence rate is considerably higher than the reported global HGC prevalence rates of 0.3%-0.7%.…”

“…The prevalence of HGC varied greatly by age and was highest among HR‐HPV‐positive women aged 50‐60 years, among whom approximately 30% had HGC in comparison with 4% of women aged 25‐29 years. Other studies have also reported increasing HGC rate by age, 16 and it is suggested that because of an altered immune system, older women are more likely to develop precancerous lesions and cancer 17 …”

Cervical cancer in Tanzania: A systematic review of current challenges in six domains

“…Seven studies investigated cervical cancer screening practices in Tanzania, with an emphasis on predictors of accessing such services. Screening methods deployed over the past six years were largely VIA-based, although Pap smears were occasionally used (Baldur-Felskov et al, 2018; Chambuso et al, 2017; Kafuruki et al, 2013; Liu et al, 2016). Multiple publications focused on improving screening programs through strengthening provider training (see Domain V).…”

“…The cumulative VIA positivity was 9.2% (n = 4062) (Table 1). HIV infection was significantly associated with precancerous changes, with 16.8% of HIV+ women also VIA+ (523/3122) (Anderson et al, 2015; Bernstein et al, 2018; Dartell et al, 2014; Baldur-Felskov et al, 2018; Masalu et al, 2017; Chambuso et al, 2017; Kafuruki et al, 2013) (Table 2). High grade dysplastic lesions were often inferred by VIA screening results due to infrequency of pathologic confirmation.…”

“…Trichomonas vaginalis increased risk for HPV 16 infection 6.5-fold (Lazenby et al, 2014). Factors positively associated with a diagnosis of VIA+ or HGSIL included high-risk HPV+, increasing age, higher gravidity, and lower body mass index, as well as untreated sexually transmitted disease(s) (Baldur-Felskov et al, 2018; Faber et al, 2017). Risk factors for invasive cancer also included being housewives or manual laborers, uneducated, widowed or separated, older, of higher gravidity, and post-menopausal (Gard et al, 2014).…”