BMC Women's Health (2018-04-01)

Evaluation of human-papillomavirus testing and visual inspection for cervical cancer screening in Rwanda

  • M. Chantal Umulisa,
  • Silvia Franceschi,
  • Iacopo Baussano,
  • Vanessa Tenet,
  • Mathilde Uwimbabazi,
  • Belson Rugwizangoga,
  • Daniëlle A. M. Heideman,
  • Anne M. Uyterlinde,
  • Teresa M. Darragh,
  • Peter J. F. Snijders,
  • Felix Sayinzoga,
  • Gary M. Clifford

DOI
https://doi.org/10.1186/s12905-018-0549-5
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 8

Abstract

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Abstract Background A pilot screening campaign in Rwanda, based on careHPV-testing followed by visual inspection with acetic acid triage (careHPV+VIA triage), was evaluated against other WHO-recommended screening options, namely HPV screen-and-treat and VIA screen-and-treat. Methods 764 women aged 30-69 underwent at visit 1: i) VIA, and cervical cell collection for ii) careHPV in Rwanda, and iii) liquid-based cytology and GP5+/6+ HR-HPV PCR in The Netherlands. All 177 women positive by VIA, careHPV and/or PCR were recalled, of whom 84% attended. At visit 2, VIA was again used to triage screen-positive women for treatment and to obtain biopsies from all women either from visible lesions or at 12 o’clock of the squamocolumnar junction. Cross-sectional screening indices were estimated primarily against histological high-grade squamous intraepithelial lesions or worse (hHSIL+), after imputation of missing histology data, based on 1-visit or 2-visit approaches. Results In a 1-visit screen-and-treat approach, VIA had sensitivity and specificity of 41% and 96%, respectively, versus 71% and 88% for careHPV, and 88% and 86% for PCR. In a 2-visit approach (in which hHSIL+ imputed among women without visit 2 were considered untreated) careHPV sensitivity dropped to 59% due to loss of 13% of hHSIL+. For careHPV+VIA triage, sensitivity dropped further to 35%, as another 24% of hHSIL+ were triaged to no treatment. Conclusions CareHPV was not as sensitive as gold-standard PCR, but detected considerably more hHSIL+ than VIA. However, due to careHPV-positive hHSIL+ women being lost to follow-up and/or triaged to no treatment, 2-visit careHPV+VIA triage did not perform better than VIA screen-and-treat.

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