Performance of HPV testing, Pap smear and VIA in women attending cervical cancer screening in Kilimanjaro region, Northern Tanzania: a cross-sectional study nested in a cohort

Abstract

ObjectiveThere is a concern about performance of the screening approaches, where information on the quality of novel and affordable screening approaches that will perform well in remote areas is warranted. This lack of information makes it difficult to prioritise resource use in efforts to improve cervical cancer outcomes. We aimed to compare the diagnostic value of human papillomavirus (HPV) testing on self-collected samples, Pap smear and visual inspection of the cervix with acetic acid (VIA) tests for detection of high-grade cervical intraepithelial neoplasia or worse (CIN2+).DesignA combined cross-sectional and cohort study.SettingThree primary healthcare centres in Kilimanjaro region, Tanzania.Participants1620 women undergoing cervical cancer screening from December 2018 to September 2021. Inclusion criteria were being aged 25–60 years, and no history of premalignant or cervical cancer. Exclusion criteria were overt signs of cancer and previous hysterectomy.InterventionsParticipants underwent HPV self-sampling with Evalyn Brush and Care HPV kit assay was used to determine prevalence of high-risk HPV infection. Women with positive HPV test were together with a random sample of HPV negative women scheduled for follow-up where VIA was performed, and Pap smear and cervical biopsies obtained.ResultsOf 1620 women enrolled, 229 (14.1%) were HPV positive and 222 of these attended follow-up together with 290 (20.8%) women with negative HPV test. On VIA, 17.6% were positive. On Pap smear, 8.0% were classified as high-grade squamous intraepithelial lesion. The sensitivity and specificity, respectively, of the various tests, compared with histopathology for the detection of CIN2+ were: HPV test 62.5%, 59.3%; Pap smear 82.8%, 82.1% and; VIA 48.4%, 56.8%. When combined, the sensitivity and specificity for HPV and Pap smear were 90.6%, 70.6% while HPV and VIA were 65.6% and 75.5% for the detection of CIN2+.ConclusionsThe performance of care HPV testing on self-collected samples opens the possibility of increasing coverage and early detection in resource-constrained settings.

Real-World Cervical Cancer Screening Uptake and Predictors of Visual Inspection With Acetic Acid Positivity Among Women Living With HIV in Care Programs in Western Kenya

“…8 Despite a 30% VIA screening coverage in both programs, the lack of access to high-performing HPV tests leaves some VIAnegative women at risk because of VIA's low sensitivity for detecting cervical precancer. [32][33][34] We found that overall VIA positivity was 15.9% across both programs (20.1% at FACES and 13.7% at AMPATH), similar to the literature in WLWHIV in SSA demonstrating VIA positivity rates among WLWHIV ranging from 9% (95% CI, 8 to 10) in Cameroon, 35 17% in Namibia, 36 and 17%-47% in Zambia. 37 The variability in VIA positivity rates, given its subjective nature, has previously been documented.…”

Effectiveness of visual inspection of Acetic Acid (VIA) and Pap Smear in cervical cancer screening: Literature review

“…VIA triage can be considered part of the cervical cancer screening strategy because it may not be possible to triage HPV-positive women using quality-assured cytology or genotyping due to costs. Through and Paps Smear assessments are utilized to emergency the HPV position of dynamic ladies to figure out who ought to be alluded for extra treatment (Mremi et al, 2022). The purpose of VIA and Paps Smear examination, according to Kemenkes RI (2019) to find precancerous lesions and determine the presence of cervical cell changes.…”

Application of HPV-16 in Liquid-Based thin Layer Cytology of Host Genetic Lesions Based on AI Diagnostic Technology Presentation of Liquid

“…Cervical lesion screening is used to judge whether women have cervical lesions and increase their attention to cervical lesions, so as to do a good job in prevention, diagnosis and treatment. It has played a vital role in ensuring women's health and life safety [3][4][5]. At present, extensive promotion has been carried out in many places in China.…”