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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Women's Health 1/2018

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

Zeitschrift:
BMC Women's Health > Ausgabe 1/2018
Autoren:
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
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12905-018-0549-5) contains supplementary material, which is available to authorized users.

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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