A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

Figures & data

Figure 1 Global distribution of HIV in Africa in 2007.

Note: Reproduced from Hotez PJ, Fenwick A, Kjetland EF. Africa’s 32 cents solution for HIV-AIDS. PLoS Negl Trop Dis. 2009;3(5):e430.⁸⁶

Figure 2 Cervical cancer age-standardized incidence rates per 100,000 women in 2008.

Note: Reproduced with permission from Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010.⁸⁷
Abbreviation: ASR, age-standardized incidence rates per 100,000 women and year.

Figure 3 Decision-making algorithm for VIA-based screening.

Note: *If available.
Abbreviations: VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol’s iodine.

Table 1 Sensitivity and specificity values of VIA among HIV-positive women across different studies

References	Country	N	HIV status	Reference test	Sensitivity (%)	Specificity (%)
Akinwuntwan et al^Citation88	Nigeria	205	HIV-positive	Histology (CIN2+)	76	83
Mabeya et al^Citation89	Kenya	150	HIV-positive	Histology (CIN2+)	70	51
Kuhn et al^Citation90	South Africa	956	Mixed	Histology (CIN2+)	64	74
Fihrnaber et al^Citation91	South Africa	1,202	HIV-positive	Histology (CIN2+)	65	69
Dartell et al^Citation92	Tanzania	3,603	Mixed	Cytology (HSIL+)	50	91
Chung et al^Citation29	Kenya	500	HIV-positive	Histology (CIN2+)	63	66
Chibwesha et al^Citation50	Zambia	200	HIV-positive	Histology (CIN2+)	48	92

Abbreviations: CIN2+, cervical intraepithelial neoplasia grade 2 or worse; HIV, human immunodeficiency virus; HSIL+, high-grade squamous intraepithelial lesion; VIA, visual inspection with acetic acid.

Table 2 Sensitivity and specificity of HPV testing among HIV-positive women across different studies

References	Country	N	HIV status	Test used	Reference test	Sensitivity (%)	Specificity (%)
Fihrnaber et al^Citation91	South Africa	1,202	HIV-positive	HC2 (Qiagen)	Histology (CIN2+)	92	51
Kuhn et al^Citation90	South Africa	956	Mixed	HC2 (Qiagen)	Histology (CIN2+)	94	64.4
Chibwesha et al^Citation50	Zambia	200	HIV-positive	GeneXpert	Histology (CIN2+)	88	60
Dartell et al^Citation92	Tanzania	3,603	Mixed	HC2 (Digene)	Cytology (HSIL+)	94.2	82.8
Chung et al^Citation29	Kenya	500	HIV-positive	Enzyme immunoassay	Histology (CIN2+)	83.6	55.7
Adamson et al^Citation65	South Africa	308	HIV-positive	Aptima HPV mRNA assay on self-collected samples	HPV mRNA assay on clinician-collected samples	77.4	77.7
Segondy et al^Citation26	South Africa	943	HIV-positive	careHPV and INNO-LiPA	Histology (CIN2+)	93.3 (careHPV) 96.7 (INNO-LiPA)	57.9 (careHPV) 32.0 (INNO-LiPA)
Ngou et al^Citation93	South Africa; Burkina Faso	160	HIV-positive	HC2 and INNO-LiPA	Histology (CIN2+)	88.8 (HC2) 92.5 (INNO-LiPA)	55.2 32.1

Abbreviations: CIN2+, cervical intraepithelial neoplasia grade 2 or worse; HC2, Hybrid Capture 2; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSIL+, high-grade squamous intraepithelial lesion.

Figure 4 Decision-making algorithm for HPV-based screening.

Abbreviations: HIV, human immunodeficiency virus; HPV, human papillomavirus; VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol’s iodine.

Table 3 Advantages and disadvantages of different CC screening options

Variable	Cytology	VIA	HPV testing
Advantages
High specificity	X
Feasible integration into a same day screen-and-treat approach		X	X
Avoids the need of a pelvic examination			X
High sensitivity			X
Disadvantages
Screening requires more than one visit	X
Need important health care infrastructure	X
Need important laboratory supplies	X
Need qualified personnel for results interpretation	X
High FN rates resulting in the need to repeat the test	X	X
High FP rates resulting in a higher risk of overtreatment		X	X

Abbreviations: CC, cervical cancer; FN, false negative; FP, false positive; HIV, human immunodeficiency virus; HPV, human papillomavirus; VIA, visual inspection with acetic acid.

HotezPJFenwickAKjetlandEFAfrica’s 32 cents solution for HIV-AIDSPLoS Negl Trop Dis200935e43019479041

 PubMed Web of Science ®Google Scholar

FerlayJShinHRBrayFFormanDMathersCParkinDMGLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]Lyon, FranceInternational Agency for Research on Cancer2010 Available from: https://www.iarc.fr/en/media-centre/iarcnews/2010/globocan2008.phpAccessed January 13, 2017

 Google Scholar

AkinwuntwanLAdesinaOAOkoloCACorrelation of cervical cytology and visual inspection with acetic acid in HIV-positive womenJ Obstet and Gynaecol200828663864119003664

 PubMedGoogle Scholar

MabeyaHKhozaimKLiuTComparison of conventional cervical cytology versus visual inspection with acetic acid (VIA) amon HIV-infected women in western KenyaJ Low Gen Tract Dis20121629297

 PubMed Web of Science ®Google Scholar

KuhnLWangCTsaiWYWrightTCDennyLEfficacy of human papillomavirus-based screen-and-treat for cervical cancer prevention among HIV-infected womenAIDS201024162553256120706107

 PubMed Web of Science ®Google Scholar

FirnhaberCMayiselaNMaoLValidation of cervical cancer screening methods in HIV positive women from Johannesburg South AfricaPLoS One201381e5349423326441

 PubMed Web of Science ®Google Scholar

DartellMARaschVIfnerTPerformance of visual inspection with acetic acid and human papillomavirus testing for detection of high-grade cervical lesions in HIV positive and HIV negative Tanzanian womenInt J Cancer2014135489690424391021

 PubMed Web of Science ®Google Scholar

ChungMHMcKenzieKDe VuystHComparing papanicolau smear, visual inspection with acetic acid and human papillomavirus cervical cancer screening methods among HIV-positive women by immune status and antiretroviral therapyAIDS201327182909291923842133

 PubMed Web of Science ®Google Scholar

ChibweshaCJFrettBKatunduKClinical performance validation of 4 point-of-care cervical cancer screening tests in HIV-infected women in ZambiaJ Low Gen Tract Dis2016203218223

 PubMed Web of Science ®Google Scholar

AdamsonPCHuchkoMJMossAMKinkelHFMedina-MarinoAAcceptability and accuracy of cervical cancer screening using a self-collected tampon for HPV messenger-RNA testing among HIV-infected women in South AfricaPLoS One2015109e013729926332236

 PubMed Web of Science ®Google Scholar

SegondyMKellyHDjimaFPerformance of careHPV for detecting high-grade cervical intraepithelial neoplasia among women living with HIV-1 in Burkina Faso and South Africa: HARP studyBr J Cancer2016115442543027434037

 PubMed Web of Science ®Google Scholar

NgouJGIlhamCOmarTComparison of analytical and clinical performances of the digene HC2 HPV DNA assay and the INNO-LiPA HPV genotyping assay for detecting high-risk HPV infection and cervical neoplasia among HIV-positive African womenJ Acquir Immune Defic Syndr2010682162168

 Web of Science ®Google Scholar