Screening for cervical cancer among HIV-positive and HIV-negative women in Cameroon using simultaneous co-testing with careHPV DNA testing and visual inspection enhanced by digital cervicography: Findings of initial screening and one-year follow-up

Cholli, Preetam; Bradford, Leslie; Manga, Simon; Nulah, Kathleen; Kiyang, Edith; Manjuh, Florence; DeGregorio, Geneva; Ogembo, R.; Orock, Enow; Liu, Yuxin; Wamai, Richard G.; Sheldon, Lisa Kennedy; Gona, Philimon; Sando, Zacharie; Welty, Thomas K.; Welty, Edith; Ogembo, Javier Gordon

doi:10.1016/j.ygyno.2017.11.002

Cited by 25 publications

(29 citation statements)

References 29 publications

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“…When comparing the studied screening techniques, the poor agreement between HPV status and VIA diagnosis is striking. Only 32% (16/50) of VIA positive cases were hrHPV positive or two third of women would be overtreated based on VIA alone which is consistent with a study from Cameroon where half of all VIA/VILI-DC positive women had no associated hrHPV infection 39 .…”

Section: Evaluation Of Screening Technologiessupporting

confidence: 87%

“…The overall VIA positivity in our study population (7.1%), diagnosed by well trained and experienced VIA nurses was similar to reports from India 47 , Cameroon 39 and Tanzania 48 but lower than in a metaanalysis of 15 studies in SSA 49 were the pooled estimate of positivity was 17.4% (95&CI 10.4 to 25.6). A high variation in test positivity is observed among VIA studies conducted world wide 49 , such discrepancies in VIA positivity is explained by patient characteristics (age, HIV status, precancer prevalence) and inherent procedure issues (high inter-operator variability, unamenable to quality control).…”

Section: Viasupporting

confidence: 85%

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Novel concepts in cervical cancer screening. A comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Orang’o

Were

Rode

et al. 2020

Preprint

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Background: Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.Methods: We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16INK4a /Ki-67 (CINtecPLUS®) dual stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology.Results: In 701 of a total of 800 women aged 18-64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5-4.3), 1.9 (95%CI 0.89-4.4) and 3.4 (95%CI 1.07-10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2-38). Conclusions: Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16INK4a/Ki-67 dual stain cytology as a triage test for HPV positive women in LMICs should be further studied.

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Section: Evaluation Of Screening Technologiessupporting

confidence: 87%

Section: Viasupporting

confidence: 85%

Novel concepts in cervical cancer screening. A comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Orang’o

Were

Rode

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The overall VIA positivity in our study population (7.1%), diagnosed by well trained and experienced VIA nurses was similar to reports from India 47 , Cameroon 39 and Tanzania 48 but lower than in a metaanalysis of 15 studies in SSA 49 were the pooled estimate of positivity was 17.4% (95&CI 10.4 to 25.6). A high variations in test positivity is observed among VIA studies conducted world wide 49 , such discrepancies in VIA positivity is explained by patient characteristics (age, HIV status, precancer prevalence) and inherent procedure issues (high inter-operator variability, unamenable to quality control).…”

Section: Viasupporting

confidence: 85%

Novel Concepts in Cervical Cancer Screening. A Comparison of VIA, HPV DNA Test and p16ink4a/Ki-67 Dual-Stain Cytology in Western Kenya.

Orang’o

Were

Rode

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.Methods: We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a p16 INK4a /Ki-67 (CINtecPLUS®) dual-stained slide that was prepared using the ThinPrep® 2000 Processor and evaluated by a pathologist trained in the methodology.Results: In 701 of a total of 800 women aged 18-64 years, all three investigations were performed and data could be analyzed. The HPV, VIA and dual-stain cytology positivity were 33%, 7%, and 2% respectively. The HPV positivity rate of VIA positive cases was 32%. The five most common HPV types were HPV16, 52, 68, 58 and 35. The OR among HIV infected women of an HPV infection, VIA positivity and positive dual stain cytology were 2.6 (95%CI 1.5-4.3), 1.9 (95%CI 0.89-4.4) and 3.4 (95%CI 1.07-10.9) respectively. The sensitivity of VIA to detect a p16INK4a/Ki-67 positive transforming infection was 13% (95%CI 2-38). Conclusions: Primary HPV testing appears feasible and should be considered as a primary screening test also in LMICs. The poor sensitivity of VIA renders it unsuitable as a triage test for HPV positive women. The utility of p16ink4a/Ki-67 dual-stain cytology as a triage test for HPV positive women in LMICs should be further studied.

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“…Community leaders were also informed about the project and encouraged women to attend cervical screening. In the second (self‐sampling) phase (May 2016), the WHP nurses and PHC staff gave health talks on cervical cancer, family planning and HIV/AIDS and obtained sociodemographic data and gynecological and obstetrical history of nonpregnant women aged 30–65 who accepted to undergo screening and who signed an informed consent . Trained LAP field workers under the supervision of WHP nurses explained the stepwise self‐collection process of vaginal specimens in both Pidgin English and the local dialect, advising the women to insert the brush into the opening where they have sex.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa

Domgue

Futuh

Ngalla

et al. 2019

Intl Journal of Cancer

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To achieve higher coverage and effectiveness in limited-resource settings, World Health Organization (WHO) guidelines for cervical cancer prevention recommend a screen-and-treat strategy with high-risk human papillomavirus (HPV) testing. We piloted a real-word project to examine the feasibility of this approach in rural Cameroon. Nurses from the Women's Health Program (WHP) of the Cameroon Baptist Convention Health Services (CBCHS) educated women in remote villages on cervical cancer prevention. At a follow-up visit, they explained to nonpregnant women aged 30-65 how to self-collect vaginal specimens for HPV testing with the careHPV assay. The cytobrush specimens were transported in coolers to a CBCHS laboratory for analysis. The nurses returned to villages to inform women of their results, examined HPV-positive women in the primary health centers (PHCs) using visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced by digital cervicography (DC) to guide treatment. Of the 1,270 eligible women screened (mean age: 44.7 years), 196 (15.4%) were HPV-positive, of whom 185 (94.4%) were examined, 16 (8.6%) were VIA/VILI-positive, 8 (4.3%) were VIA/VILI-inadequate, one (0.5%) was VIA/VILI-uncertain and 161 (87.0%) were treated with thermal ablation. One woman had LEEP, and another woman with invasive cancer was treated at a referral facility. The cytobrushes broke off in the vaginas of two women (removed in the village) and in the bladder of another (surgically removed). Community-based cervical cancer screening with self-collected specimens for HPV testing is feasible in rural Cameroon. Education on the proper sampling procedure and follow-up of women who are HPV-positive are essential.

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Screening for cervical cancer among HIV-positive and HIV-negative women in Cameroon using simultaneous co-testing with careHPV DNA testing and visual inspection enhanced by digital cervicography: Findings of initial screening and one-year follow-up

Cited by 25 publications

References 29 publications

Novel concepts in cervical cancer screening. A comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Novel concepts in cervical cancer screening. A comparison of VIA, HPV DNA test and p16INK4a/Ki-67 dual stain cytology in Western Kenya.

Novel Concepts in Cervical Cancer Screening. A Comparison of VIA, HPV DNA Test and p16ink4a/Ki-67 Dual-Stain Cytology in Western Kenya.

Feasibility of a community‐based cervical cancer screening with “test and treat” strategy using self‐sample for an HPV test: Experience from rural Cameroon, Africa

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