Diagnostic accuracy of visual inspection with acetic acid versus Papanicolaou smear in cervical cancer screening among HIV-positive women in rural Nigeria

Akhere E. Oshodin, Eustace E. Ehikioya, Okelue E. Okobi, Anthonia I. Njoku, Felix O. Okogbo, Stella Ehi Egege, Olamma A. Dike, Ifunanya C. Modebelu, Omowunmi Adewara

Abstract

Cervical cancer remains a significant reproductive and public health concern, particularly among women living with Human Immunodeficiency Virus (HIV) in low-resource settings like Irrua community in Edo State Nigeria. This study aimed to compare the sensitivity and specificity of visual inspection with acetic acid (VIA) and the Papanicolaou smear (Pap smear) as screening methods for premalignant and malignant cervical lesions in HIV-positive women. A comparative cross-sectional design was employed, involving 136 HIV-positive women who met the inclusion criteria. Suspicious or well-defined aceto-white areas observed during VIA were biopsied and subjected to histopathological examination. The sensitivity of VIA was higher than that of the Pap smear (94.1% vs. 73.5%), whereas its specificity was lower (25% vs. 79.5%). When both methods were combined, the screening performance improved, yielding higher sensitivity, specificity, positive predictive value, and negative predictive value (92.3%, 87.5%, 92.3%, and 87.5%, respectively) than either test alone. These findings indicate that VIA demonstrates higher sensitivity than the Pap smear, while using both methods in combination enhances overall diagnostic accuracy. We recommend that VIA can therefore serve as an effective complementary screening tool to the Pap smear for the early detection of cervical cancer, particularly in resource-constrained healthcare settings. Keywords: Cervical cancer, HIV-positive women, Pap smear, Visual Inspection with Acetic Acid (VIA), Screening methods, Sensitivity and specificity, Low-resource settings, Premalignant lesions, Histopathology, Comparative cross-sectional study.

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Oche MO, Kaoje AU, Gana G, and Ango JT. Cancer of the cervix and cervical screening: Current knowledge, attitude and practices of female health workers in Sokoto, Nigeria. Int J Med Med Sci 2013; 5(4): 184-90.

Vum, Yuj, Awoiude OA, and Chuangl L. Cervical cancer worldwide. Current Problems in Cancer 2018; 42(5): 457-65.

World Health Organization. Comprehensive Cervical Cancer Control: A Guide to Essential Practice. 2nd ed. Geneva: WHO; 2014.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, and Bray F. Global Cancer statistics 2020; GLOBOCAN estimate of incidence and mortality worldwide for 36 cancer in 185 countries. CA: A Cancer Journal for Clinicians 2021; 71(3): 209-49.

Cuzick J, Arbyn M, Sankaranarayanan R, Tsu V, Ronco G, Mayrand MH, Dillner J, and Meijer CJ. Overview of human papillomavirus based and other novel options for cervical cancer screening in developed and developing countries. Vaccine 2008; 26(10): K29–K41.

Oluwole EO, Mohammed AS, Akinyinka MR, and Salako O. Cervical cancer awareness and screening uptake among rural women in Lagos, Nigeria. Journal of Community Medicine and Primary Health Care 2017; 29(10): 81-8.

Durowade KA, Osagbemi GK, Salawudeen AG, Musa OI, Akande TM, and Babatunde OA. Prevalence and risk factors of cervical cancer among women in an urban community of Kwara State, North central Nigeria. J Prev Hyg 2012; 53: 213-19.

Burki T. UNAIDS and IAEA join forces on HIV and cervical cancer. The Lancet 2020; 395(10223): 484.

Bassey G, Jeremiah I, Ikimalo JI, Fiebai PO, and Athanasius BP. Abnormal cervical cytology among HIV-positive women in Nigeria. Int J Gynaecol Obstet 2014; 1252: 103-106.

Odafe S, Torpey K, Khamofu H, Oladele E, Adedokun O, Chabikuli O, Mukaddas H, Usman Y, Aiyenigba B, and Okoye M. Integrating cervical cancer screening with HIV care in a district hospital in Abuja, Nigeria. Niger Med J 2013; 54: 176-84.

World Health Organization. Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey.

Owoeye IOG and Ibrahim IA. Knowledge and attitude towards cervical cancer screening among female students and staff in a tertiary institution in the Niger Delta. IJMBR 2013; 2(1).

World Health Organization (WHO). Prevention of cervical cancer through screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy. Nigeria: WHO; 2012 p. 1-33.

Ibrahim T. Research Methodology and Dissertation Writing for Health and Allied Health Professionals. Abuja. Cress Global Link Limited 2009.58.

Israel G. D, 2012. Determining sample size. University of Florida, institute for Food and Agricultural Sciences. 2012

Araoye MO. Subjects Selectionin Research Methodology with statistics for Health and Social sciences. Ilorin. Nathadex publishers, 2003: 115-129.

Mabeya H, Khozaim K, Liu T, Orango O, Chumba D, Pisharodi L, Carter J, and Cu-Uvin S. Comparison of conventional cervical cytology versus visual inspection with acetic acid among human immunodeficiency virus infected women in Western Kenya. J Low Genit Tract Dis 2012; 16(2): 92–7.

Council for International Organisations of Medical Sciences (CIOMS) International Ethical Guidelines for Biomedical Research Involving Human Subjects. 2002.

World Health Organisation Standards and Operational Guidance for Ethics Review of Health- Related Research with Human Participants. 2011.

Perkins RB, Langrish S, Stern LJ, Figueroa J, and Simon CJ. Visual inspection with acetic acid is more cost-effective than Pap smears for cervical cancer screening in Honduras. Doctoral Dissertation 2007.

Ahmed I, Arja R, and Vibeke R. Cervical cancer screening in primary health care setting in Sudan :a comparative study of VIA and Pap smear. Int J Women’s Health 2012; 4: 67-73.

Muwonge R, Manuel MG, Filipe AP, Dumas JB, Frank MR, and Sankaranarayanan R. Visual screening for early detection of cervical neoplasia in Angola. Journal of Gynaecology and Obstetrics 2010; 111: 68-72.

Were E, Nyaberi Z, and Buziba N. Integrating cervical cancer and genital tract infection screening into mother, child health and family planning clinics in Eldoret, Kenya. African Health Sciences 2010; 10: 58-65.

Ogunbowale T and Lawoyin TO. Cervical cancer risk factor and predictors of cervical dysplasia among women in southwest Nigeria. Aust J Rural Healthy 2008; 16: 338-42.

Ekalaksananan T, Pientong C, Thinkhamrop J, Kongyingyoes B, Evans MF, and Chaiwongkot A. Cervical cancer screening in north east Thailand using the visual inspection with aceti cacid(VIA) test and its relationship to high-risk human papilloma virus(HR-HPV) status. Journal of Obstetrics and Gynecological Research 2010; 36: 1037-43.

Doh AS, Nkele NN, Achu P, Essimbi F, Essame O, and Nkegoum B. Visual inspection with Acetic acid and cytology as screening method for cervical lesion in Cameroon, International Journal of Gynecology and Obstetrics 2015; 89: 167-73.

Akinola OI, Fabamwo AO, Oshodi YA,Banjo AA, Odusanyo O, Gbadagesin A, and Tayo A. Efficacy of visual inspection using acetic acid in cervical cancer screening: A comparison with cervical cytology. J Obstet Gynaecol. 2007; 27: 703-5.

Ogunbowale T and Lawoyin TO. Cervical cancer risk factor and predictors of cervical dysplasia among women in southwest Nigeria. Aust J Rural Healthy 2008; 16: 338-42.

Samuels F, Blake C, Akinrimisi B. HIV vulnerabilities and the potential for strengthening social protection responses in the context of HIV in Nigeria. London: ODI. 2012 Feb 21.

Odukogbe AA, Awolude OA, Oluwasola AOT, Adewole FI, and Omigbodun AO. Guidelines and Standard of Care Manual for Managing Gynaecological Cancers In Gynaecological Oncology Unit, Dept of Obstet and Gynaecol, college of med, Univ of Ibadan/UCH, Ibadan.1st edition, Ibadan: Ibadan University Press 2014. p. 1.

Omole-Ohonsi A. Risk factors for cervical dysplasia in Aminu Kano Teaching Hospital. Ibom Med J 2014; 634-9.

Ononogbu U, Almujtaba M, Modibbo F, Lawal I, Offiong R, Olaniyan O, Dakum P, Spiegelman D, Blattner W, and Adebamowo C. Cervical cancer risk factor among HIV infected Nigerian women. BMC public health 2013; 13(1): 1-10.

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