Background
Acording to 2008 estimates, invasive cervical cancer (ICC) is the third most common cancer in women worldwide with an estimated 530,232 new cases annually and is responsible for 275,180 deaths. More than 85% of these new ICCs and 88% of these cancer deaths occur in resource-limited settings [
1]. In sub-Saharan Africa, a significant association between HIV infection and ICC has been reported, although it has been much less strong compared to reports from resource-replete settings [
2]. Since 2002, access to antiretroviral treatment (ART) has been dramatically scaled up with four million HIV-infected patients accessing ART in sub-Saharan Africa at the end of 2009 [
3]. As the coverage of ART in low-resource settings continues to improve the prognosis of HIV-infected individuals, it is likely to be translated into years of life saved [
4]. Thus, a focus on long-term case management is now needed, especially for women who account for approximately two-thirds of HIV-infected patients receiving ART in sub-Saharan Africa. In high-resource countries, cytology-based cervical screening has curbed the incidence of cervical cancer for decades [
5]. Due to human resource and infrastructure shortages, previous experiences in Côte d'Ivoire as well as other sub-Saharan countries highlighted a lack of reliability of cytology-based cervical screening at the population level [
6,
7]. Cervical screening procedures based on the identification of high-risk human papilloma viruses (HPV) have a high capacity to detect precancerous cervical lesions [
8,
9]. However, these techniques are currently too work-intensive and expensive to be largely implemented. Low cost, cervical screening procedures based on visual inspection (VI) of the cervix have been proposed and adapted to resource-limited settings for years [
10‐
12]. Although having a lower sensitivity and specificity than HPV tests, they have shown an equal validity compared to cytology in HIV-negative as well as HIV-positive women in resource-limited settings [
13,
14]. A successful experience with the implementation of such a cervical screening procedure targeting HIV-infected women has been recently reported in Zambia but experiences from other parts of sub-Saharan Africa are limited [
15,
16]. We therefore sought to compare some of the critical operational and clinical outcomes of a cervical cancer screening based on VI methods among HIV-negative and HIV-positive women in Abidjan, Côte d'Ivoire.
Acknowledgements
We are indebted to all of the women who agreed to participate in this present study as well as to the midwives who performed the cervical screening procedures and the data collection. We are also indebted to Mrs Rosamonde Yao, Mr Severin Lenaud and Mr Jean-Claude Azani for their implication in data entry and data management process.
The IeDEA West Africa collaboration is organized as follows. * Member of the IeDEA West Africa Technical Committee
- Primary Investigators: Pr François Dabis* (INSERM U897, ISPED, Bordeaux, France), Pr Emmanuel Bissagnene* (SMIT, CHU de Treichville, Abidjan, Côte d'Ivoire)
- Clinical Investigators by country and alphabetical order: Jocelyn Akakpo, Alain Azondékon, Jules Bashi, Sagbo Gratien, Sikiratou Koumakpaï, Marcel D. Zannou* (Benin); Ye Diarra, Eric-Arnaud Diendere, Joseph Drabo*, Fla Koueta (Burkina Faso); Edmond Aka-Addi, Clarisse Amani-Bosse, Franck-Olivier Ba-Gomis, François Eboua-Tanoh, Serge-Paul Eholie*, Calixte Guehi, Kouakou Kouadio, Serge-Olivier Koulé, Eugène Messou, Albert Minga, Aristophane Tanon, Marguerite Timité-Konan, Pety Touré, (Côte d'Ivoire); Kevin Peterson* (Gambia); Bamenla Goka, Lorna Renner* (Ghana); Hadizatou Coulibaly, Fatoumata Dicko, Moussa Maiga*, Daouda Minta, Mariam Sylla, Hamar Alassane Traoré; Man Charurat* (Nigeria); Bernard Diop, Fatou Ly Ndiaye, Papa Salif Sow, Haby Signaté Sy*, Judicaël Tine (Senegal)
- Epidemiology and Statistical Unit (INSERM U897, ISPED, Université Victor Segalen, Bordeaux, France): Eric Balestre, Didier K. Ekouévi*, Antoine Jaquet*, Valériane Leroy*, Charlotte Lewden*, Karen Malateste, Annie J. Sasco, Rodolphe Thiebaut
- Data Management Unit (PACCI, CHU Treichville, Abidjan, Côte d'Ivoire): Gérard Allou, Jean Claude Azani, Patrick Coffie
- Administration: Alexandra Doring and Elodie Rabourdin (ISPED), Hughes Djétouan, Bertin Kouadio and Adrienne Kouakou (PACCI)
- Adult clinical centers by city and country:
Abidjan, Côte d'Ivoire: Médecine Interne et Tropicale (SMIT), CHU de Treichville, Unité de Soins Ambulatoires et de Conseil (USAC), Centre Médical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, ACONDA-MTCT-Plus, ACONDA-CePReF, Centre Intégré de Recherche Bioclinique d'Abidjan (CIRBA). Abuja, Nigeria: University of Abuja Teaching Hospital (UATH). Bamako, Mali: Service d'Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Centre de Prise en Charge des Personnes vivant avec le VIH, Hôpital du Point G. Dakar, Sénégal: Service des Maladies Infectieuses, CHU de FANN/ISAARV. Banjul, Gambia: Fajara Cohort. Benin City, Nigeria: University of Benin Teaching Hospital (UBTH) Cotonou, Benin: Service de Médecine Interne, CNHU Hubert Maga. Ouagadougou, Burkina-Faso: Service de Médecine Interne, CHU Yalgado
- Pediatric clinical centers by city and country:
Abidjan, Côte d'Ivoire: ACONDA-CEPREF, ACONDA-MTCT-Plus, CHU de Yopougon, Centre Intégré de Recherche Bioclinique d'Abidjan (CIRBA). Accra, Ghana: Korle Bu Teaching Hospital. Bamako, Mali: Hôpital Gabriel Touré. Cotonou, Benin: Centre National Hospitalo-Universitaire Hubert Maga, Hôpital d'Instruction des Armées. Dakar, Senegal: Hôpital d'Enfants Albert-Royer. Fajara, Gambia: Medical Research Council. Ouagadougou, Burkina-Faso: Centre Hospitalier Charles de Gaulle.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
AH, AJ, DKE, FD and AJS designed the study. AH and BT conducted the clinical work and cervical screening training. AJ, DKE and AH supervised the study. BE supervised the pathological examinations. Statistical analysis was done by AJ and interpretation of data was done by AH and AJ The manuscript was drafted by AJ and critical revision of the manuscript for important intellectual content was provided by AH, AJS, DKE, PAC, RM and FD All authors read and commented on the original manuscript and all agreed on the version finalised by AJ for submission.