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 |
| |
Authors: | 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 |
| |
Affiliation: | 1. University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA 01655, United States;2. Cameroon Baptist Convention Health Services, PO Box 1, Bamenda, North West Region, Cameroon;3. Regional Hospital, PO Box 32, Buea, Cameroon;4. Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States;5. Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States;6. Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275, United States;g. Yaoundé Gyneco-Obstetric and Pediatric Hospital, Yaoundé, PO Box 4362, Central Region, Cameroon;h. Beckman Research Institute of City of Hope, 1500 E Duarte Road, Duarte, CA 91010, United States |
| |
Abstract: | ObjectiveThe 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.MethodsWe 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.ResultsOn 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.ConclusionsWe 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. |
| |
Keywords: | Cervical cancer screening HPV DNA testing Visual inspection with acetic acid Women's health Sub-Saharan Africa |
本文献已被 ScienceDirect 等数据库收录! |
|