High-risk human papillomavirus in HIV-infected women undergoing cervical cancer screening in Lilongwe, Malawi: a pilot study

Reddy, Deepa; Njala, Joseph; Stocker, Penny; Schooley, Alan; Flores, Martiniano; Tseng, Chi‐Hong; Pfaff, Colin; Jansen, Perry; Mitsuyasu, Ronald T.; Hoffman, Risa M.

doi:10.1177/0956462414539149

Cited by 20 publications

(24 citation statements)

References 37 publications

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“…Only few studies have assessed HrHPV as a risk factor for VIA positivity. In agreement with our results, some report significantly increased risk , while others found a non‐significant decreased risk in HPV‐positive compared with HPV‐negative women . A prospective cohort study conducted in rural China found that VIA positivity was influenced by testing HPV‐positive with a high viral load (>100 rlu/pc which is equal to 100 pg/ml) .…”

Section: Discussionsupporting

confidence: 91%

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

Baldur-Felskov

Mwaiselage

Faber

et al. 2018

Tropical Med Int Health

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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.

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Section: Discussionsupporting

confidence: 91%

“…Laboratory personnel were blinded to the data associated with the samples. The testing was done by the Hybrid Capture 2 method (HC2; Qiagen, Hildesheim, Germany), which detects at least 13 HrHPV types (16,18,31,33,35,39,45,51,52,56,58, 59 and 68) [14]. Samples attaining ≥1.0 pg/ml of HPV DNA were considered positive.…”

Section: Hpv Testingmentioning

confidence: 99%

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

Baldur-Felskov

Mwaiselage

Faber

et al. 2018

Tropical Med Int Health

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“…(23) Another study among women living with HIV also found a higher prevalence of hr-HPV at 38%. (22) We also found BV prevalence in our population in line with findings from other research in Malawi (45% and 52% in two different sites in Malawi). (24) A study among young women in Malawi found a lower HSV-2 prevalence of only 26%.…”

Section: Discussionsupporting

confidence: 92%

“…Limited data exist on the prevalence of hr-HPV among Malawian women, and there are no nationwide data on HPV prevalence. (21,22) Similar to our findings, one study found an HPV prevalence (including both low and high risk HPV) of 23% among women without HIV, but found among women with HIV the HPV prevalence was 58%. (23) Another study among women living with HIV also found a higher prevalence of hr-HPV at 38%.…”

Section: Discussionsupporting

confidence: 89%

Intravaginal Practices and Prevalence of Sexual and Reproductive Tract Infections Among Women in Rural Malawi

Esber

Rao

Norris³

et al. 2016

Sexual Trans Dis

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Background Many women engage in intravaginal practices (IVP) with a goal of improving genital hygiene and increasing sexual pleasure. IVP can disrupt the genital mucosa, and some studies have found that IVP increases risk of acquisition of HIV and bacterial vaginosis (BV). Limited prior research also suggests significant associations between IVP, herpes simplex virus type 2 (HSV-2), and high-risk types of human papillomavirus (HPV). Methods We examined associations between IVP and HPV, BV, and HSV-2 among 200 women in rural Malawi participating in a clinic-based study on sexual and reproductive tract infections. We calculated prevalence ratios for the associations between frequency and type of IVP and outcomes of HPV, BV, and HSV-2. Results Intravaginal practices were commonly performed, with 95% of women reporting current use of at least one practice. Infections were also frequently detected: 22% of the sample had at least one high risk HPV type, 51% had BV, and 50% were HSV-2 seropositive. We observed no significant associations between type of IVP, frequency of IVP, or a combined measure capturing type and frequency of IVP – and any of the infection outcomes. Conclusions While both IVP and our outcomes of interest (BV, HPV, and HSV-2) were common in the study population, we did not detect associations between IVP type or frequency and any of the three infections. However, the high prevalence and frequency of IVP may have limited our ability to detect significant associations.

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“…36 Comparative studies are not always possible in resource-constrained settings, but sufficient data points should be recorded of key indicators to allow outcomes and should include long-term efficacy through followup of treated women, safety profile (e.g., pregnancy outcomes), and data on client experience. Future models of screen-and-treat should explore the use of HPV testing for potential triage to VIA as recommended by WHO and others 13,[37][38][39] : refinement of optimal treatment strategies for HIV-positive compared to HIV-negative women, 37 as well as investment in effective, cost-effective and acceptable treatment such as thermo-coagulation. There is also a need for health systems research into how to implement evidence on screening delivery in practice, 40,41 as well as integration with HIV/ART and reproductive health services.…”

Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

Campbell

Kafwafwa

Brown

et al. 2016

Intl Journal of Cancer

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The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermo‐coagulation has been acknowledged as a safe and acceptable procedure suitable for low‐resource settings. We introduced thermo‐coagulation for treatment of VIA‐positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high‐grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo‐coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3‐ to 6‐month cure rates of more than 90% are observed. Thermo‐coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo‐coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women.

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High-risk human papillomavirus in HIV-infected women undergoing cervical cancer screening in Lilongwe, Malawi: a pilot study

Cited by 20 publications

References 37 publications

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

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

Intravaginal Practices and Prevalence of Sexual and Reproductive Tract Infections Among Women in Rural Malawi

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

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