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

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

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Objective The World Health Organization (WHO)'s cervical cancer screening guidelines for limited-resource settings recommend sequential screening followed by same-day treatment under a “screen-and-treat” approach. We aimed to (1) assess feasibility and clinical outcomes of screening HIV-positive and HIV-negative Cameroonian women by pairing visual inspection with acetic acid and Lugol's iodine enhanced by digital cervicography (VIA/VILI-DC) with careHPV, a high-risk human papillomavirus (HR-HPV) nucleic acid test designed for low-resource settings; and (2) determine persistence of HR-HPV infection after one-year follow-up to inform optimal screening, treatment, and follow-up algorithms. Methods We co-tested 913 previously unscreened women aged ≥ 30 years and applied WHO-recommended treatment for all VIA/VILI-DC-positive women. Baseline prevalence of HR-HPV and HIV were 24% and 42%, respectively. Results On initial screen, 44 (5%) women were VIA/VILI-DC-positive, of whom 22 had HR-HPV infection, indicating 50% of women screened false-positive and would have been triaged for unnecessary same-day treatment. VIA/VILI-DC-positive women with HIV infection were three times more likely to be HR-HPV-positive than HIV-negative women (65% vs. 20%). All women positive for either VIA/VILI-DC or HR-HPV (n = 245) were invited for repeat co-testing after one year, of which 136 (56%) returned for follow-up. Of 122 women who were HR-HPV-positive on initial screen, 60 (49%) re-tested negative, of whom 6 had received treatment after initial screen, indicating that 44% of initially HR-HPV-positive women spontaneously cleared infection after one year without treatment. Women with HIV were more likely to remain HR-HPV-positive on follow-up than HIV-negative women (61% vs. 22%, p < 0.001). Treatment was offered to all VIA/VILI-DC positive women on initial screen, and to all women screening VIA/VILI-DC or HR-HPV positive on follow-up. Conclusions We found careHPV co-testing with VIA/VILI-DC to be feasible and valuable in identifying false-positives, but careHPV screening-to-result time was too long to inform same-day treatment.

Original languageEnglish
Pages (from-to)118-125
Number of pages8
JournalGynecologic Oncology
Volume148
Issue number1
DOIs
StatePublished - Jan 2018
Externally publishedYes

Keywords

  • Cervical cancer screening
  • HPV DNA testing
  • Sub-Saharan Africa
  • Visual inspection with acetic acid
  • Women's health

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