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

• Published in: Gynecologic oncology 2018-01, Vol.148 (1), p.118-125
• Main Authors: Cholli, Preetam, Bradford, Leslie, Manga, Simon, Nulah, Kathleen, Kiyang, Edith, Manjuh, Florence, DeGregorio, Geneva, Ogembo, Rebecca K., Orock, Enow, Liu, Yuxin, Wamai, Richard G., Sheldon, Lisa Kennedy, Gona, Philimon N., Sando, Zacharie, Welty, Thomas, Welty, Edith, Ogembo, Javier Gordon
• Format: Article
• Language: English
• Subjects: Cervical cancer screening; HPV DNA testing; Sub-Saharan Africa; Visual inspection with acetic acid; Women's health
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2017.11.002

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. We co-tested 913 previously unscreened women aged ≥30years and applied WHO-recommended treatment for all VIA/VILI-DC-positive women. Baseline prevalence of HR-HPV and HIV were 24% and 42%, respectively. 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