| dc.description.abstract | Purpose: The World Health Organization (WHO) recommends human papillomavirus (HPV) as a primary screening test within "screen-and-treat" cervical cancer programs in low- and middle-income countries (LMICs). Following a positive test, two alternative strategies are endorsed within the single-visit approach. All HPV positive women can be offered immediate treatment, or visual inspection with acetic acid (VIA) is used to triage. Thus, we calculated the positive predictive value (PPV) of VIA for histologically confirmed CIN2+ among HPV-positive women living with HIV (WLWH).
Methods: Between August 2019 and March 2020, as part of a clinical trial (NCT04191967) in western Kenya, high-risk HPV-positive WLWH age 25-65 years underwent VIA and colposcopy-directed biopsies regardless of VIA result. All women received treatment. The PPV of VIA for CIN2+ was determined.
Results: Three hundred and sixty-six HPV-positive WLWH were evaluated during the study period. Mean age was 40.2 years (SD 8.5), median CD4 count was 420 (IQR 359), and 94.5% were virally suppressed. Seventy-four (20.2%) women had CIN2+ on histology (14 CIN2, 54 CIN3, six microinvasive carcinoma), of whom only 33 were also VIA-positive. The PPV of VIA for diagnosis of CIN2+ was 44.6% (95% CI 33.0 – 56.6) and was similar when limited to CIN3+. The PPV decreased with age, ranging from 72.7% (95% CI 54.5–86.7), to 24.2% (95% CI 11.1 – 42.3) to 3.0% (95% CI 0.1 – 15.8) among ages 30-39 years, 40-49 years, and 50 years and greater, respectively.
Conclusions: While HPV testing has low specificity among WLWH, triage with VIA has a low positive predictive value for CIN2+ and would result in missed opportunities for treatment in this high-risk population. This highlights the need for more objective, affordable, and accessible triage tests, e.g. artificial intelligence-assisted cervicography or biomarkers of dysplasia to improve the PPV of the HPV-based screen-and-treat single-visit approach in LMICs.
Citation Format: Chemtai Mungo, Cyrillus Ogollah, Jennifer Ambaka, Magdalene Randa, Jackton Omoto, Craig Cohen. To Triage or Not? Positive Predictive Value of Visual Inspection with Acetic Acid for Diagnosis of Cervical Intraepithelial Neoplasia Grade 2 or Worse (CIN2+) among HIV-Positive Women in a Low-Resource Setting [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 69. | en_US |
