Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-Infected Women in Lusaka, Zambia

Bateman, Allen C.; Parham, Groesbeck P.; Sahasrabuddhe, Vikrant V.; Mwanahamuntu, Mulindi; Kapambwe, Sharon; Katundu, Katundu; Nkole, Theresa; Mulundika, Jacqueline; Pfaendler, Krista S.; Hicks, Michael L.; Shibemba, Aaron; Vermund, Sten H.; Stringer, Jeffrey S. A.; Chibwesha, Carla J.

doi:10.1097/qai.0000000000000270

Cited by 26 publications

(29 citation statements)

References 14 publications

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“…21 Among HIV-infected women in Zambia, DC was at least as good as cytology for detecting highgrade precancers. 22 In this study, DC was compared to cytology at a CIN 2+ cutoff, and cytology sensitivity and specificity were 61% and 58%, respectively, compared to DC (84% and 58%, respectively). Colposcopic interobserver agreement studies based on reviewing digitized colposcopic photographs of acetic acidstained cervixes (similar to reviewing DC photographs) showed a K of 0.57 (moderate agreement).…”

Section: Discussionmentioning

confidence: 96%

Cervical Cancer Screening in Cameroon

Manga

Parham

Benjamin

et al. 2015

Journal of Lower Genital Tract Disease

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Section: Discussionmentioning

confidence: 96%

Cervical Cancer Screening in Cameroon

Manga

Parham

Benjamin

et al. 2015

Journal of Lower Genital Tract Disease

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“…11,15,21 Not surprisingly, Xpert HPV, an HPV DNA PCR assay, demonstrated high sensitivity and moderate specificity for CIN2+ (88% and 60%, respectively). Previous validation studies of the Xpert HPV in the U.S. have yielded similar results, with the initial evaluation (n=141) demonstrating that Xpert HPV was equally sensitive for high-grade squamous intra-epithelial lesions (HSIL) as Cobas HPV (90.8% vs. 90.8%) and more sensitive than Digene HC2 (90.8% vs. 81.6%, p=0.004).…”

Section: Discussionmentioning

confidence: 98%

Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia

Chibwesha

Frett

Katundu

et al. 2016

J Low Genit Tract Dis

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Objectives We sought to determine the clinical performance of visual inspection with acetic acid (VIA), digital cervicography (DC), Xpert HPV, and OncoE6 for cervical cancer screening in an HIV-infected population. Methods HIV-infected women 18 years and older were included in this cross-sectional validation study conducted in Lusaka, Zambia. The screening tests were compared to a histological gold standard. We calculated sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and odds ratios using cervical intra-epithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+) thresholds. Results Between January and June 2015, 200 women were enrolled. 15% were screen positive by VIA, 20% by DC, 47% by Xpert HPV, and 6% by OncoE6. Using a CIN2+ threshold, the sensitivity and specificity of VIA was 48% (95% confidence interval [CI]: 30-67%) and 92% (95% CI: 86-95%), respectively. Similarly, the sensitivity and specificity of DC was 59% (95% CI: 41-76%) and 88% (95% CI: 82-93%). The sensitivity and specificity of Xpert HPV was 88% (95% CI: 71-97%), and 60% (95% CI: 52-68%). Finally, the sensitivity and specificity of OncoE6 was 31% (95% CI: 16-50%) and 99% (95% CI: 97-100%). Conclusions VIA and DC displayed moderate sensitivity and high specificity. Xpert HPV performed equivalently to currently approved HPV DNA tests, with high sensitivity and moderate specificity. OncoE6 displayed excellent specificity but low sensitivity. These results confirm an important role for VIA, DC, and Xpert HPV in screen-and-treat cervical cancer prevention in low- and middle-income countries, such as Zambia.

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“…Digital images of suspicious lesions are reviewed in real-time by gynecologists at remote tertiary care sites. Even among HIV-infected women, the sensitivity of DC-VIA to detect CIN 2/3 lesions was higher than Pap testing [28]. Thus, task shifting from physicians to nurse-led programs can lower costs and expand access without compromising effectiveness.…”

Section: Discussionmentioning

confidence: 99%

An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan Africa

Coleman

Cespedes

Cu‐Uvin

et al. 2016

Journal of Lower Genital Tract Disease

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OBJECTIVE Approximately 85% of cervical cancer cases and deaths occur in resource-constrained countries where best practices for prevention, particularly for HIV-infected women, still need to be developed. The objective of this study was to assess cervical cancer prevention capacity in select HIV clinics located in resource-constrained countries. METHODS A cross-sectional survey of sub-Saharan African sites of four NIH-funded HIV/AIDS networks was conducted. Sites were surveyed on the availability of cervical cancer screening and treatment among HIV-infected and HIV-uninfected women. Descriptive statistics, and chi-square or Fisher’s exact test were used as appropriate. RESULTS Fifty-one out of 78 (65%) sites responded. Access to cervical cancer screening was reported by 49 (96%) sites. Of these sites, 39 (80%) performed screening on-site. Central African sites were less likely to have screening on-site (P= 0.02) versus other areas. Visual inspection with acetic acid (VIA) and Pap testing were the most commonly available on-site screening methods at 31 (79%) and 26 (67%) sites, respectively. High-risk HPV testing was available at 29% of sites with VIA and 50% of sites with Pap testing. Cryotherapy and radical hysterectomy were the most commonly available on-site treatment methods for premalignant and malignant lesions at 29 (74%) and 18 (46%) sites, respectively. CONCLUSION Despite limited resources, the majority of sites surveyed had the capacity to perform cervical cancer screening and treatment. The existing infrastructure of HIV clinical and research sites may provide the ideal framework for scale up of cervical cancer prevention in resource-constrained countries with a high burden of cervical dysplasia.

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Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-Infected Women in Lusaka, Zambia

Cited by 26 publications

References 14 publications

Cervical Cancer Screening in Cameroon

Cervical Cancer Screening in Cameroon

Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia

An Insight Into Cervical Cancer Screening and Treatment Capacity in Sub Saharan Africa

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