Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status

Abstract

BackgroundCervical cancer screening is not yet standard of care of women attending HIV care clinics in Africa and presents operational challenges that need to be addressed.MethodsA cervical cancer screening program based on visual inspection methods was conducted in clinics providing antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire. An itinerant team of midwives was in charge of proposing cervical cancer screening to all HIV-positive women enrolled in ART clinics as well as to HIV-negative women who were attending the Abidjan national blood donor clinic. Positively screened women were systematically referred to a colposcopic examination. A phone-based tracking procedure was implemented to reach positively screened women who did not attend the medical consultation. The association between HIV status and cervical cancer screening outcomes was estimated using a multivariate logistic model.ResultsThe frequency of positive visual inspection was 9.0% (95% CI 8.0-10.0) in the 2,998 HIV-positive women and 3.9% (95% CI 2.7-5.1) in the 1,047 HIV-negative ones (p < 10-4). In multivariate analysis, HIV infection was associated with a higher risk of positive visual inspection [OR = 2.28 (95% CI 1.61-3.23)] as well as more extensive lesions involving the endocervical canal [OR = 2.42 (95% CI 1.15-5.08)]. The use of a phone-based tracking procedure enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5% to 19.8% (p < 10-4).ConclusionThe higher frequency of positive visual inspection among HIV-positive women supports the need to extend cervical cancer screening program to all HIV clinics in West Africa. Women loss to follow-up after being positively screened is a major concern in cervical screening programs but yet, partly amenable to a phone tracking procedure.

Cervical Cancer Prevention in Malawi: A Qualitative Study of Women's Perspectives

“…Studies have documented that a host of psychological and sociocultural factors contribute to nonparticipation in cervical cancer prevention, including limited knowledge about cervical cancer and screening; stigma, cultural beliefs, and perceptions related to the reproductive organs and symptoms; limited finances; lack of time; and not wanting to know more about cervical cancer status (Anorlu, 2008;Francis et al, 2011;Fort et al, 2011;Horo et al, 2012;Taulo, 2008;Wellensiek, Moodley, Moodley, & Nkwanyana, 2002). Studies have also documented that health care workers often have poor knowledge about cervical cancer and that weak health infrastructure impedes screening (Ayinde & Omigbodun, 2003;Tarwireyi, Chirenje, & Rusakaniko, 2003).…”

Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

“…Monitoring is recommended, but the treatment is acceptable. We systematically treated lesions due to strong possibility of being lost to follow-up (36% in a similar study in an HIV clinic) [18]. …”

Classification of cervical cancer tissues using a novel low cost methodology for effective screening in rural settings

“…Cervical screening procedures and the data collection confirm that HIV-infected women are at higher risk of presenting a positive cervical screening test as well as histological precancerous lesions compared to HIV negative women, highlighting the need to extend cervical cancer screening to all HIV care clinics in West Africa [3].…”

“…In the developed countries the availability of resources has reduced the rate of cervical cancer through cytological screening for many years [2]. However, the colposcopy systems in the Western countries are expensive due to the optics and software [3]. While the Pap smear screening is the common choice for cervical screening, it is not always practical to administer, particularly in areas where the test is not available or is out of the price range of the patient.…”