The burden of cervical pre-cancer and cancer in HIV positive women in Zambia: a modeling study

Bateman, Allen C.; Katundu, Katundu; Mwanahamuntu, Mulindi; Kapambwe, Sharon; Sahasrabuddhe, Vikrant V.; Hicks, Michael L.; Benjamin, H.; Stringer, Jeffrey S. A.; Parham, Groesbeck P.; Chibwesha, Carla J.

doi:10.1186/s12885-015-1558-5

Cited by 24 publications

(33 citation statements)

References 26 publications

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“…Specifically, 3% of women were diagnosed with ICC and 13% with high-grade CIN. It should be noted that the burden of cervical disease in our study was somewhat lower than in previously published Zambian studies, which have reported that ∼30-50% of HIV-infected women are VIA/DC positive, 18,19 20% have CIN2+, 19 and 53% are hrHPV positive. 20 These studies were conducted before cART was widely available in Zambia and before the introduction of the so-called Option B+ strategy (through which the overwhelming majority of HIV-infected women of reproductive age have obtained access to cART regardless of their CD4+ cell count), possibly accounting for the observed differences.…”

Section: Discussioncontrasting

confidence: 78%

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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Section: Discussioncontrasting

confidence: 78%

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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“…Although WHO 2013 guidance does not include thermo‐coagulation as a treatment modality, there is growing use of and support for thermo‐coagluation in a number of LMIC settings . As evidence accumulates for non‐inferior outcomes for thermo‐coagluation pre‐cancers compared to other treatment modalities, guidance should be reviewed and updated.…”

Section: Discussionmentioning

confidence: 99%

“…Although WHO 2013 guidance does not include thermo-coagulation as a treatment modality, there is growing use of and support for thermo-coagluation in a number of LMIC settings. 12,13,[31][32][33] As evidence accumulates for noninferior outcomes for thermo-coagluation pre-cancers compared to other treatment modalities, 12,24,34 guidance should be reviewed and updated. Similarly, health care planners in LMICs should consider inclusion of thermo-coagulation in strategic planning for long-term cost-effectiveness and sustainable delivery of screening programmes.…”

Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

Campbell

Kafwafwa

Brown

et al. 2016

Intl Journal of Cancer

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The incidence of cervical cancer in Malawi is the highest in the world and projected to increase in the absence of interventions. Although government policy supports screening using visual inspection with acetic acid (VIA), screening provision is limited due to lack of infrastructure, trained personnel, and the cost and availability of gas for cryotherapy. Recently, thermo‐coagulation has been acknowledged as a safe and acceptable procedure suitable for low‐resource settings. We introduced thermo‐coagulation for treatment of VIA‐positive lesions as an alternative to cryotherapy within a cervical screening service based on VIA, coupled with appropriate, sustainable pathways of care for women with high‐grade lesions and cancers. Detailed planning was undertaken for VIA clinics, and approvals were obtained from the Ministry of Health, Regional and Village Chiefs. Educational resources were developed. Thermo‐coagulators were introduced into hospital and health centre settings, with theoretical and practical training in safe use and maintenance of equipment. A total of 7,088 previously unscreened women attended VIA clinics between October 2013 and March 2015. Screening clinics were held daily in the hospital and weekly in the health centres. Overall, VIA positivity was 6.1%. Almost 90% received same day treatment in the hospital setting, and 3‐ to 6‐month cure rates of more than 90% are observed. Thermo‐coagulation proved feasible and acceptable in this setting. Effective implementation requires comprehensive training and provider support, ongoing competency assessment, quality assurance and improvement audit. Thermo‐coagulation offers an effective alternative to cryotherapy and encouraged VIA screening of many more women.

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“…Compared to cobas in the entire population, OncoE6 was less sensitive but more specific. The high specificity makes it possible to be applied to screening high HPV‐prevalence, high‐risk populations, such as cervical cancer screening in HIV‐infected women . Moreover, OncoE6 might be used for primary screening in LMICs in place of VIA, which is already being widely used, to achieve a similar or superior sensitivity but higher specificity to reduce colposcopy referral numbers and avoiding overtreatment under an already over burdened health‐care system in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of human papillomavirus 16/18 oncoprotein test for cervical cancer screening and HPV positive women triage

Jiang

et al. 2018

Intl Journal of Cancer

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HPV-16 and -18 account for about 80% of cervical cancers. We evaluated the performance of HPV-16/18 oncoprotein to predict precancer and cancer in corresponding tissue biopsy specimens. 1,008 women attending cervical cancer screening program and 638 women referred to colposcopy with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from 4 hospitals were recruited (1,646 in total). All women were tested OncoE6 (AVC), Liquid-Based Cytology (Hologic) and cobas HPV test (Roche). Colposcopy was performed on women with any abnormal results. The final diagnoses were based on a consensus panel review of the histology. There were 919 normal, 69 CIN1, 53 CIN2, 91 CIN3,474 squamous cell carcinoma(SCC) and 40 adenocarcinoma (ADC) cases, the prevalence of OncoE6 was 1.7%, 10.1%, 13.2%, 44.0%, 80.4% and 65.0%, respectively. The percent positive for cobas was higher than that of OncoE6 in detection of HPV16/18 in entire population (p < 0.001). However, the disparity of positive rate between these two tests became tiny among cervical cancer patients (CIN2: 26.4% vs. 13.2%, CIN3: 73.6% vs. 44.0%, SCC: 84.0% vs. 80.4%, ADC: 67.5% vs. 65.0%). OncoE6 was less sensitive than cobas (73.9% vs. 93.6%, p < 0.001), but more specific (97.1% vs. 75.4%, p < 0.001) for CIN3+ in entire population; OncoE6 yielded a sensitivity of 77.7% and a specificity of 91.0% for CIN3+ among cobas positive women, which can reduce nearly half of the colposcopy referral numbers. OncoE6 can be considered as a useful tool for cervical cancer screening and a potential powerful biomarker for HPV positive triage.

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The burden of cervical pre-cancer and cancer in HIV positive women in Zambia: a modeling study

Cited by 24 publications

References 26 publications

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

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

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

Clinical evaluation of human papillomavirus 16/18 oncoprotein test for cervical cancer screening and HPV positive women triage

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