Abstract
BackgroundHIV 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.MethodsA 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.FindingsVIA 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.ConclusionsThis 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.
Highlights
Compared to HIV-negative women, women infected with HIV have higher prevalence rates and longer persistence of human papillomavirus (HPV) infection, the primary cause of cervical cancer, and higher rates of cervical dysplasia, the precursor of invasive cervical cancer.[1,2] cervical cancer incidence and mortality rates are higher in countries with high HIV prevalence rates and few resources for screening and prevention.[3,4]Because invasive cervical cancer does not develop until approximately 10–15 years after initial HPV infection, there is an opportunity to diagnose and treat cervical cancer precursors and to interrupt progression to cancer.[5]
Guyana: the generous support of the 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
Cervical cancer incidence and mortality rates are higher in countries with high HIV prevalence rates and few resources for screening and prevention.[3,4]
Summary
Because invasive cervical cancer does not develop until approximately 10–15 years after initial HPV infection, there is an opportunity to diagnose and treat cervical cancer precursors and to interrupt progression to cancer.[5] Since the introduction of cervical cytology, mortality from cervical cancer in developed countries has decreased by more than 70%. The lifetime risk of cervical cancer can be reduced by approximately 80–90% by screening women every three to five years.[6] in countries with limited resources, implementation of cervical cytology services is constrained by the inadequate health infrastructure, including a lack of cytopathologists and cytology technicians to prepare and analyze Pap smears, and the need for follow-up visits for further evaluation and treatment when Pap smears are abnormal.[7]. This study’s objective was to examine cervical cancer screening using VIA/SVA in programs serving HIV-infected women
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