Performance of careHPV, hybrid capture 2 and visual inspection with acetic acid for detection of high-grade cervical lesion in Tanzania: A cross-sectional study

Abstract

Objective To examine the test performance of care HPV, Hybrid Capture2 (HC2) and visual inspection with acetic acid (VIA) for detection of cytologically diagnosed high-grade cervical lesions or cancer (HSIL+). Design Cross-sectional study. Setting Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Center (KCMC), Tanzania. Population Women attending routine cervical cancer screening. Method We enrolled 4080 women (25–60 years) in the study. The women were interviewed on lifestyle habits, and tested for HIV. A cervical specimen for care HPV testing (performed at ORCI and KCMC), and a liquid-based cytology sample for HPV DNA detection using HC2 (performed at Tuebingen University Hospital, Germany) and for cytology assessment (performed at Vejle Hospital, Denmark) were obtained at a gynecological examination. Subsequently, VIA was performed. With cytology as gold standard, the sensitivity and specificity of care HPV, HC2, and VIA for detection of HSIL+ were calculated. Results Altogether, 23.6% had a positive care HPV test, 19.1% had positive HC2 test, and 6.3% had a positive VIA test. The sensitivity/specificity was 88.9%/78.9% for care HPV and 91.1%/83.7%, for HC2. VIA showed a low sensitivity of 31.1% but a high specificity (94.6%) for detection of HSIL+. The sensitivity of care HPV, HC2 and VIA was higher among younger women, and among HIV positive women. VIA triage of care HPV positive women improved specificity, but sensitivity dropped to 27%. Conclusion Our results confirm the low sensitivity of VIA for detection of HSIL+ and further document that care HPV test is promising as a primary screening method for cervical-cancer prevention in low-resource regions. A suitable triage test has to be identified.

Novel concepts in cervical cancer screening: a comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya

“…We found a high overall burden (32.5%) of high-risk HPV infections in our study population, similar to results from another study in our Western Kenya region [34]. A number of other studies done in SSA report lower [33,[35][36][37][38][39] or similarly high [40,41] HPV burden. All these studies were facility-based with often unknown cervical morbidity and different distribution of risk factors for HPV acquisition, i.e.…”

“The best thing is that you are doing it for yourself” – perspectives on acceptability and feasibility of HPV self-sampling among cervical cancer screening clients in Tanzania: a qualitative pilot study

“…This qualitative study is a sub-study of a larger research project called CONCEPT (Comprehensive Cervical Cancer Prevention in Tanzania), which is a five-year international project (2015-2019) between Ocean Road Cancer Institute (ORCI), Kilimanjaro Christian Medical Centre (KCMC), The Danish Cancer Society and University of Southern Denmark (SDU). The aim of CONCEPT is to improve cervical cancer prevention in Tanzania, and it has multidisciplinary sub-studies [10,11,34] including establishment of a cohort of 4000 women in order to get regionalspecific data on the natural history of cervical cancer and investigate the potential of HPV testing as a primary screening method.…”

“…In Tanzania, the standard screening method is visual inspection with acid (VIA), which requires a gynaecological examination [4]. However, studies have questioned the sensitivity and specificity of VIA [11][12][13] and therefore rapid HPV testing is currently being tested as a promising primary method for cervical cancer screening. HPV testing usually requires a gynaecological examination, however, a vaginal sampling can also be taken by the woman herself, which is referred to as HPV self-sampling or self-testing.…”

The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

“…N=5/6 of the women tested positive for hrHPV was VIA -ve. This is not surprising as the careHPV system consistently yielded a higher sensitivity of 71-90% (8,36) while VIA has a much lower sensitivity of 21.9% (37) although it can uctuate to as high as 73.6% (38), depending on the operator. This observation supports the higher sensitivity of the careHPV system compared to VIA.…”