Acid For Cervical Cancer Screening Research Articles

Cost-utility analysis of primary HPV testing through home-based self-sampling in comparison to visual inspection using acetic acid for cervical cancer screening in East district, Sikkim, India, 2023.

Primary Human Papilloma Virus (HPV) testing offers higher sensitivity and specificity over Visual Inspection using Acetic acid (VIA) in cervical cancer screening. Self-sampling is a promising strategy to boost participation and reduce disparities. However, concerns about the initial costs hinder HPV testing adoption in low and middle-income countries. This study assesses the cost-utility of home-based HPV self-sampling versus VIA for cervical cancer screening in India. A cross-sectional study was conducted in East district, Sikkim, India, comparing the costs and utility outcomes of population-based cervical cancer screening through VIA and primary HPV screening through self-sampling. Cost-related data were collected from April 2021 to March 2022 using the bottom-up micro-costing method, while utility measures were collected prospectively using the EuroQoL-5D-5L questionnaire. The utility values were converted into quality-adjusted life days (QALDs) for an 8-day period. The willingness to pay threshold (WTP) was based on per capita GDP for 2022. If the calculated Incremental Cost-Effectiveness Ratio (ICER) value is lower than the WTP threshold, it signifies that the intervention is cost-effective. The study included 95 women in each group of cervical cancer screening with VIA & HPV self-sampling. For eight days, the QALD was found to be 7.977 for the VIA group and 8.0 for the HPV group. The unit cost per woman screened by VIA and HPV self-testing was ₹1,597 (US$ 19.2) and ₹1,271(US$ 15.3), respectively. The ICER was ₹-14,459 (US$ -173.6), which was much below the WTP threshold for eight QALDs, i.e. ₹ 4,193 (US$ 50.4). The findings support HPV self-sampling as a cost-effective alternative to VIA. This informs policymakers and healthcare providers for better resource allocation in cervical cancer screening in Sikkim.

Performance of visual Inspection With Acetic Acid for Cervical Cancer Screening as Compared to Human papillomavirus Deoxyribonucleic acid Testing Among Women With HIV in Ethiopia: A Comparative Cross-sectional Study.

ObjectivesThe aim of this study was to evaluate the performance of visual inspection with acetic acid compared with Human papillomavirus Deoxyribonucleic acid (HPV DNA) testing among women with HIV in Ethiopia.MethodsA comparative cross-sectional study was conducted to address the aforementioned objective. Data were collected from January to October 2021, to compare the performance of these two screening modalities. Trained clinicians collected cervical specimens and immediately applied acetic acid for visual inspection. The HPV DNA testing was done using Abbott m2000rt/SP by trained laboratory professionals in accredited laboratories. A total of 578 women with HIV aged 25-49 years were included.ResultsTest positivity was 8.9% using visual inspection with acetic acid (VIA) and 23.3% using HPV DNA test. The sensitivity and specificity of the VIA test were 19.2% and 95.1%, respectively. The strength of agreement between the two screening methods was poor (k = .184). The burden of genetic distribution of high risk HPV16 was 6.1%, and HPV18 was 1.1%. Other high risk HPV types (ie non-HPV 16/18 high risk HPV genotypes) were predominant in this study (18.6%).ConclusionThe higher positivity result using HPV DNA testing compared with VIA, and low sensitivity of VIA are indicating that the implementation of HPV DNA testing as the primary screening strategy is likely to reduce cervical cancer cases and deaths of women in the country.

Positive participant experiences with smart-phone based enhanced visualization with acetic acid for cervical cancer screening in mysore, India

The goal of this study was to evaluate the experiences of participants screened with a smart-phone based imaging system for enhanced visualization with acetic acid (VIA) for cervical cancer screening where Pap smears are not feasible in semi-urban and rural Mysore, India.

Visual Inspection with Acetic Acid for Cervical Cancer Screening: Bangladesh Perspective

Abstract not available Faridpur Med. Coll. J. Jul 2018;13(2): 56-57

A Study of Sensitivity of Visual Inspection of the Cervix with Acetic Acid in Cervical Cancer Screening

Visual inspection tests with 3–5% acetic acid (VIA) and/or Lugol’s iodine (VILI) appear to be a satisfactory alternative screening approach to cytology. These tests have been used since the 1990s, mainly in poor-resource settings. They are simple and cost-effective with relative ease of use and may be performed by different health care workers (physicians, nurse, midwives and technicians). Moreover, this approach does not require high technology or infrastructure and has been shown to reduce mortality in developing countries. The study was conducted on 1000 women recruited for gynaecology outpatient clinic at El Shatby Maternity University Hospital after giving of written consent. VIA was done by applying 3–5% acetic acid to the cervix using a cotton swab, checking the transformation zone carefully for any dense, non-movable aceto-white areas in the epithelium or any raised and thickened white plaques. The summary sensitivity and specificity of VIA were 84.1% and 53.8%, respectively; VIA was sensitive in detecting more severe outcome, although there was a slight loss in specificity. Apparent heterogeneity existed in sensitivity and specificity for VIA. High sensitivity of VIA was found when a combination of colposcopy and histology was used as disease confirmation, so it could be a good option for cervical screening in low-resource settings.

Visual Inspection Test with Acetic Acid for Cervical Cancer Screening: Willingness and Acceptability among Reproductive Age and Married Women

Background: Cervical cancer is a preventable disease, thus early screening test should be performed for early cervical cancer prevention. Previous studies showed that among all of the screening techniques, visual inspection with acetic acid is an alternative, simple safe cervical cancer prevention technique. This study aimed to identify the willingness and acceptability of visual inspection with acetic acid among reproductive age and married women as cervical cancer prevention. Methods: A descriptive cross-sectional study was conducted among 100 reproductive age and married women in Jatinangor subdistrict West Java in 2014. A validated questionnaire was used to obtain information about the respondents’s characteristics, risk factors of cervical cancer, willingness and acceptability of Visual Inspection using Acetic Acid Test (VIA). The collected data were presented using tables. Results: Out of 100 respondents, 93% ever heard of cervical cancer, however 79% were aware of cervical cancer. As high as 96% were aware of the importance of cervical cancer screening, however 36% were aware of cervical cancer screening, and 19% were aware of VIA test. While 83% never had previous education on cervical cancer, 91% reported willingness to take part on cervical cancer education and 83% willingness of cervical cancer screening. Noted 17% were non-acceptance of VIA test for future cervical cancer screening due to their busy life and afraid of the outcome result. Conclusions: The majority of reproductive age and married women are willing and accept VIA test for cervical cancer screening.

The Utility of Visual Inspection with Acetic Acid in Cervical Cancer Screening

Objective: Cervical cancer is potentially preventable but still remains a leading cause of cancer mortality in in developing countries like Nigeria. Cytology-based screening programmes are difficult to maintain in these countries. Developing a cheap and reliable alternative is an important public health measure in these regions. This study was carried out to compare the utility of VIA and Pap smear as Cervical cancer screening methods in HIV-infected and non HIV-infected women. Methodology: Between March, 2013 and March, 2014, 461 consenting women, comprising 231 HIV positive women (HPW) and 230 HIV negative women (HNW) were recruited and screened for cervical cancer using conventional Pap smear and VIA simultaneously in University of Uyo Teaching Hospital. The Pap smear findings were classified using the 2001 Bethesda system. Patients with a positive Pap smear or abnormal VIA findings were recalled for biopsy. The results of the two tests were compared using biopsy as the gold standard. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value for VIA were 100%,80%,76.9%, and 100%, respectively compared to 80%, 100%, 100%, and 88.2% for conventional Pap smear. Visual inspection of the cervix with acetic acid for cervical cancer screening is not specific but has a high negative predictive value. Conclusion: This study does not support a “see-and-treat” approach in cervical cancer management using VIA only. In resource-challenged areas, VIA can be applied on a large scale basis in primary screening for cervical cancer so as to triage, women who will benefit from further evaluation before applying the appropriate treatment.

Cervical Cancer Screening

<p>Cervical cancer is the fourth most common cancer in women in the world and second commonest cancer in less developed countries. It is estimated that 528, 000 cases are reported ever year with 80% reported in underdeveloped countries.<sup>1</sup> It is one of the few cancers which have a well defined, approachable and early detectable pre cancerous stage which takes 10 – 15 years to transform into invasive disease. Exposure to HPV infection especially 16 & 18 along with risk factors of early age in first intercourse, multiple sexual partners, and smoking and low socio economic status all make women more vulnerable to cervical cancer.<sup>2</sup> According to recent PDHS survey, women in Pakistan marry at a median age of 19.5 years and 8% of teenage pregnancy happen.<sup>3</sup> Extra marital sex is prevalent although not talked about much. In Pakistan incidence of cervical cancer is reported to be 3.6% of all cancers with screening coverage of 1.9%.<sup>4</sup></p><p> Effective screening program of Pap smear has resulted in decline of incidence and mortality in the developed world. The standard practice is to screen women using cytology every 3 years starting from 21 – 65 years.<sup>5</sup> In contrast, this program is a failure in the developing countries because of lack of laboratory infrastructure, trained cytologist, cost and follow up visit requirement especially in rural areas. The menace of disease is visible when it is already spreaded adding the threat to human life and burden to health care system.</p><p> The visual inspection of cervix with acetic acid (VIA) has been advocated as an alternative screening method to Pap smear in developing countries. It comprises of application of 5% acetic acid to the cervix and visualization of acetowhite area. It is simple, cheap, and easy to perform, does not require lab infrastructure and can be learnt easily. WHO guideline<sup>6</sup> suggests VIA as recommended screening method in developing countries. VIA has been evaluated in large number of clinical trials in India, Bangladesh and Africa in terms of sensitivity, specificity, positive & negative predictive value in detecting CIN and has been found a reliable screening test.<sup>7-10</sup> HPV DNA testing is now the recommended screening test according to recent AS-CO guideline.<sup>11</sup> Screening in developing countries has been addressed in this guideline for the very first time and VIA has been suggested for basic settings.</p><p> Effective treatment approaches in the form of Cryotherapy, LEEP/LETTZ and cold knife conization are present for cervical premalignancy. Screen and treat approach at single visit is now recommended by WHO in low and middle income countries.<sup>6</sup></p><p> More than 2 million women worldwide have cervical cancer. Despite evidence that cervical cancer has declined in certain regions of the world and that survival in women with this cancer has improved, far too many women die from this cancer every year in developing countries due to lack of effective screening programmes. Primary prevention in the form of HPV vaccine was introduced 10 years ago but it is still not widely used in resource poor countries due to its cost.<sup>12</sup> Interventions that do not require massive capital investment are available and need to be explored in low resource settings, where access to early detection of cervical cancer is generally limited. It is hoped that decision makers are enlightened about possible alternative strategy in the form of visual inspection of acetic acid for cervical cancer screening that could improve the lives of women by early detection, destigmatize this disease in community, and ensure that they remain on the healthcare agenda. A three prong strategy including sexual health education, screening and HPV vaccination should be global health priority to reduce burden of this highly preventable cancer.</p>

MHealth to Train Community Health Nurses in Visual Inspection With Acetic Acid for Cervical Cancer Screening in Ghana.

There is a shortage of trained health care personnel for cervical cancer screening in low-/middle-income countries. We evaluated the feasibility and limited efficacy of a smartphone-based training of community health nurses in visual inspection of the cervix under acetic acid (VIA). During April to July 2015 in urban Ghana, we designed and developed a study to determine the feasibility and efficacy of an mHealth-supported training of community health nurses (CHNs, n = 15) to perform VIA and to use smartphone images to obtain expert feedback on their diagnoses within 24 hours and to improve VIA skills retention. The CHNs completed a 2-week on-site introductory training in VIA performance and interpretation, followed by an ongoing 3-month text messaging-supported VIA training by an expert VIA reviewer. Community health nurses screened 169 women at their respective community health centers while receiving real-time feedback from the reviewer. The total agreement rate between all VIA diagnoses made by all CHNs and the expert reviewer was 95%. The mean (SD) rate of agreement between each CHN and the expert reviewer was 89.6% (12.8%). The agreement rates for positive and negative cases were 61.5% and 98.0%, respectively. Cohen κ statistic was 0.67 (95% CI = 0.45-0.88). Around 7.7% of women tested VIA positive and received cryotherapy or further services. Our findings demonstrate the feasibility and efficacy of mHealth-supported VIA training of CHNs and have the potential to improve cervical cancer screening coverage in Ghana.

Uptake of community-based, self-collected HPV testing vs. visual inspection with acetic acid for cervical cancer screening in Kampala, Uganda: preliminary results of a randomised controlled trial.

To compare two cervical cancer screening methods: community-based self-collection of high-risk human papillomavirus (HR-HPV) testing and visual inspection with acetic acid (VIA). Pilot randomised controlled trial of 500 women aged 30-65 in the community of Kisenyi, Uganda. Women randomised to self-collection-based HR-HPV testing provided a cervico-vaginal swab for HR-HPV, and results were provided by phone after laboratory testing. Women who tested HPV positive were referred for VIA at the local health unit. Women randomised to VIA underwent screening at the local health unit, where women who tested positive with VIA were provided cryotherapy at time of screening, as per local standard of care. Women were referred for colposcopy when indicated. Outcome measures were uptake of screening, HR-HPV prevalence, VIA result and treatment rates. In the HR-HPV arm, 248 of 250 (p<0.01) women provided samples, while in the VIA arm, 121 of 250 (48.4%) women attended screening. Among the 73 of 248 HR-HPV-positive women, 45.2% (N=33) attended VIA screening for follow-up, 21.2% (N=7) of whom screened positive; five received treatment and two were missing clinical follow-up records. Of the 121 women in the VIA arm who attended screening, 13.2% (N=16) screened positive; seven received cryotherapy, three refused treatment, five were referred to colposcopy; and one woman had suspected cervical cancer and received treatment after confirmatory testing. This pilot study demonstrated trial feasibility and willingness of the women to participate and be randomised successfully into the two arms. Self-collection-based cervical cancer screening had a higher uptake than VIA.

Comparing the results of Pap smear and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening.

Background:Cervical cancer is the most second common cancer among Iranian women. This study was carried out to compare the results of Pap smear method and Direct Visual Inspection (DVI) with 5% acetic acid in cervical cancer screening in Tabriz, Iran.Material and Methods:This cross-sectional study was carried out in Alzahra Therapeutic-Educational Centre, Tabriz, Iran in 2013 on 1000 women. First, Pap smear was done for all women, and then the cervix exposed with 5% acetic acid by cotton swab for 30 seconds and observed under adequate light. At the end, women with abnormal results in Pap smear or DVI method were referred to colposcopy and biopsy. Test's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), LR+, LR- and confidence interval (CI) were determined (P < 0.05).Results:Nine-hundred and seventy-four (94.7%) cases were normal and had no abnormal findings and 26 (2.6%) participants had positive results in Pap smear or DVI test. Twelve women had abnormal Pap smear (nine women with atypical squamous cells of undetermined significance, ASCUS, three women with dysplasia, atypical endocervical, and low-grade squamous intraepithelial lesion, LSIL results) and 14 women had positive DVI (four women with human papillomavirus, HPV or koilocyte,) and one women with abnormality in both method had carcinoma in biopsy that referred to oncologist. In this study the sensitivity, specificity, PPV and NPV for DVI were 71.4%, 50%, 35.7%, and 81.8% respectively in comparison with 14.3%, 50%, 10%, and 60% for Pap smear.Conclusion:As the DVI method has higher sensitivity and positive predictive value than Pap smear, it could be used as a useful method beside the Pap smear.

Effectiveness of a two-stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low-income setting.

The World Health Organization recently advocated a two-stage strategy with human papillomavirus (HPV) testing followed by visual inspection of the cervix with acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on self-obtained specimens (self-HPV) followed by VIA (sequential testing) in a low-income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian periurban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV-negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia Grade 2 or worse (CIN2+). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN2+ were 36.4% [95% confidence interval (CI): 15.2-64.6%] and 90.4% (95% CI: 85.4-93.7%), respectively. Sensitivity of self-HPV [100.0% (95% CI: 79.6-100.0%)] was 66% higher than that of sequential testing [33.3% (95% CI: 15.2-58.3%)]. Meanwhile, specificity of self-HPV [74.5% (95% CI: 70.6-78.1%)] was 22% lower than that of sequential testing [96.7% (95% CI: 94.8-97.9%)]. A two-stage screening strategy with self-HPV followed by VIA improves specificity of cervical cancer screening, but at the cost of an important loss of sensitivity. Ways to improve VIA performance or other tools are needed to increase positive predictive value of HPV testing.

Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening

To examine the determinants of a positive visual inspection after acetic acid (VIA), including the relationship of testing positive for high-risk human papillomavirus (HR-HPV), which is the necessary cause of cervical cancer. A prospective cohort study. Three clinical sites in rural China. A total of 7541 women aged 25-65years. All women underwent VIA, DNA testing, by two DNA tests performed on both clinician- and self-collected specimens, and HPV E6 oncoprotein testing. Those positive by any test underwent colposcopy and four-quadrant biopsy evaluation. A random sample of women with negative screening results also underwent colposcopy and, if colposcopic abnormalities were observed, four-quadrant biopsy evaluation was performed. Women diagnosed with cervical intraepithelial neoplasia grade2 (CIN2), or more severe grades (CIN2+), underwent treatment. Testing positive for VIA. Overall, 7.6% (95% confidence interval, 95%CI, 7.0-8.2%) had a positive VIA. Women who tested positive for HPV were more likely to have a positive VIA than women who tested negative for HPV (15.0%, 95%CI 12.9-17.2% versus 6.3%, 95%CI 5.7-6.9%; P<0.001). Older women were less likely to have a positive VIA (Ptrend <0.001), including women with CIN2+ (Ptrend <0.001). A logistic regression model demonstrated that diagnosis (CIN2+ versus <CIN2; odds ratio, OR, 32; 95%CI 11-100), testing HPV positive with a higher viral load (highest versus lowest; OR4.3; 95%CI 2.5-7.4), and age (51years and older versus <38years; OR0.22; 95%CI 0.17-0.30) were independent determinants of having a positive VIA. VIA was more likely to be positive for women with CIN2+having an abnormal colposcopic impression versus women with CIN2+ regardless of colposcopic impression (71.4 versus 47.2%). The age of the population and method of disease ascertainment should be considered in the interpretation of any VIA performance.

Visual Inspection With Acetic Acid in Cervical Cancer Screening

Visual inspection with acetic acid (VIA) is an attractive screening method for early-phase cervical cancer in underdeveloped countries. This study addressed the validity of VIA in cervical cancer screening by comparing results with colposcopy findings. Of 350 women screened at the Ege University clinic using the Papanicolaou test, colposcopy and VIA were used additionally to screen 50 of these women. Colposcopy, VIA, and Papanicolaou test results were compared. A sociodemographic data questionnaire and a VIA questionnaire were used. When VIA findings were compared with Papanicolaou test findings, the sensitivity of VIA was 82.14%, specificity was 50.00%, positive predictive value (PPV) was 67.64%, and negative predictive value (NPV) was 68.75%. When the method of VIA was compared with colposcopy, VIA had a sensitivity of 85.29%, specificity of 68.75%, PPV of 85.29%, and NPV of 68.75%. In the screening of cervical cancer, the sensitivity of VIA was high, whereas the corresponding specificity was only at an acceptable level. The PPV and NPV of VIA were found to be high. In other words, the validity of VIA during early-phase screening is high in terms of sensitivity and acceptable for specificity and predictive values. Visual inspection with acetic acid is an acceptable screening method for cervical cancer and seems to be an efficient and cost-effective method to detect high-level dysplasia.

Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology

SummaryScreening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 – 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Visual inspection with acetic acid for cervical cancer screening outside of low-resource settings

To assess visual inspection with acetic acid (VIA) as a screening tool for use in a well-equipped health center in Peru, to evaluate VIA as an alternative or adjunct to the Papanicolaou (Pap) smear, and to determine if VIA can play a role in settings other than low-resource ones. This was a prospective study of 1 921 asymptomatic women living in Lima, Peru, carried out in 1999 and 2000. The study was performed at a cancer center equipped with the latest-generation technology and highly trained oncologists. The women underwent a complete clinical evaluation, including a Pap smear and VIA. Participants with any positive test were referred for colposcopy and biopsy. More women tested positive by VIA than on the Pap smear (6.9% vs. 4.2%; P = 0.0001). There were 35 women with histologic cervical intraepithelial neoplasia grade 1 (CIN 1); of these, 15 were detected by Pap and 20 by VIA (P = 0.4). A diagnosis of CIN 2 or 3 (CIN 2-3) was confirmed in a total of 13 cases; Pap detected 5 of the cases and VIA 11 of the cases (P = 0.06). The positive predictive value for detection of CIN 2+ was 8.3% for VIA and 6.3% for Pap (P = 0.5). Most importantly, while only 2.3% of patients with a positive VIA were lost to follow-up before colposcopy, that was true for 26.3% of the women with a positive Pap smear (P < 0.0001). VIA is useful for detection of precursor lesions of cervical cancer not only in low-resource settings but also in well-equipped health centers and cancer centers. In these non-low-resource settings, VIA has a positive predictive value comparable to the conventional Pap smear, but it is more likely to achieve earlier diagnosis, follow-up, and treatment than cytology-based screening.

Performance of visual inspection with acetic acid for cervical cancer screening: a qualitative summary of evidence to date.

Developing countries often lack the necessary resources to use the Papanicolaou (Pap) smear as a screening tool for cervical abnormalities. Because the burden of cervical cancer is highest in such low-resource settings, alternative techniques have been sought. Recently, interest in visual inspection with acetic acid (VIA) has increased. Numerous studies have been conducted on its accuracy and its ability to detect cervical lesions when compared with other techniques, both conventional and nonconventional. This review summarizes key findings from the literature to provide researchers and policymakers with an up-to-date summary on VIA. PubMed was used to identify relevant journal articles published between 1982 and 2002. Key words were cervical cancer screening, visual inspection, VIA (visual inspection with acetic acid), DVI (direct visual inspection), AAT (acetic acid test), and cervicoscopy. Studies were eligible for review only if they involved analysis of primary VIA data (ie, not review articles); studies involving magnification devices were excluded. Fifteen studies were reviewed in total; key results were extracted and a summary analysis was performed for sensitivity and specificity parameters. When reported, sensitivity ranged between 66% and 96% and specificity between 64% and 98%. Authors comparing VIA with cytology noted that the overall usefulness of VIA compares favorably with that of the Pap test. The reported findings reviewed here suggest that VIA has the potential to be a cervical cancer screening tool, especially in low resource settings. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to describe how visual inspection of the cervix for cervical cancer screening (VIA) is performed, to summarize the current literature on VIA, and to list potential advantages of VIA.