Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia
Objective This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit.Methods and analysis We conducted a paired, prospective study among...
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BMJ Publishing Group
2024-07-01
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| Series: | BMJ Oncology |
| Online Access: | https://bmjoncology.bmj.com/content/3/1/e000111.full |
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| author | Nicola Low Partha Basu Andreas Limacher Katayoun Taghavi Misinzo Moono Mulindi Mwanahamuntu Herbert Kapesa Albert Manasyan Julia Bohlius Marie Roumet Thamsanqa Madliwa Anne Rutjes |
| author_facet | Nicola Low Partha Basu Andreas Limacher Katayoun Taghavi Misinzo Moono Mulindi Mwanahamuntu Herbert Kapesa Albert Manasyan Julia Bohlius Marie Roumet Thamsanqa Madliwa Anne Rutjes |
| author_sort | Nicola Low |
| collection | DOAJ |
| description | Objective This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit.Methods and analysis We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18–65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was cervical intraepithelial neoplasia grade 2 and above (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius) and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% CIs. A sensitivity analysis considered disease when only visible lesions were biopsied.Results Women included in the study had well-controlled HIV infection (median CD4 count=542 cells/mm3) and all except one were on antiretroviral therapy. Among 371 participants with histopathological results, 27% (101/371) women had CIN2+ and 23% (23/101) were not detected by any index test. Sensitivity and specificity for stand-alone tests were: hrHPV, 67.3% (95% CI 57.7% to 75.7%) and 65.3% (95% CI 59.4% to 70.7%); Gynocular 51.5% (95% CI 41.9% to 61.0%) and 80.0% (95% CI 74.8% to 84.3%); and VIA 22.8% (95% CI 15.7% to 31.9%) and 92.6% (95% CI 88.8% to 95.2%), respectively. Combining tests did not improve test accuracy measures. All test accuracies improved in sensitivity analysis.Conclusion The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed.Trial registration number NCT03931083. |
| format | Article |
| id | doaj-art-afc32ecab0054dfaa7b2313cefec710a |
| institution | Kabale University |
| issn | 2752-7948 |
| language | English |
| publishDate | 2024-07-01 |
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| series | BMJ Oncology |
| spelling | doaj-art-afc32ecab0054dfaa7b2313cefec710a2025-01-30T06:15:12ZengBMJ Publishing GroupBMJ Oncology2752-79482024-07-013110.1136/bmjonc-2023-000111Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, ZambiaNicola Low0Partha Basu1Andreas Limacher2Katayoun Taghavi3Misinzo Moono4Mulindi Mwanahamuntu5Herbert Kapesa6Albert Manasyan7Julia Bohlius8Marie Roumet9Thamsanqa Madliwa10Anne Rutjes11Institute of Social and Preventative Medicine, University of Bern, Bern, SwitzerlandInternational Agency for Research on Cancer, Lyon, FranceDepartment of Clinical Research, University of Bern, Bern, SwitzerlandInstitute of Social and Preventative Medicine, University of Bern, Bern, SwitzerlandCenter for Infectious Disease Research in Zambia, Lusaka, ZambiaUniversity of Zambia University Teaching Hospital, Lusaka, ZambiaCenter for Infectious Disease Research in Zambia, Lusaka, ZambiaCenter for Infectious Disease Research in Zambia, Lusaka, ZambiaInstitute of Social and Preventative Medicine, University of Bern, Bern, SwitzerlandDepartment of Clinical Research, University of Bern, Bern, SwitzerlandDepartment of histopathology, Lancet Laboratories, Richmond, South AfricaInstitute of Social and Preventative Medicine, University of Bern, Bern, SwitzerlandObjective This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit.Methods and analysis We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18–65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was cervical intraepithelial neoplasia grade 2 and above (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius) and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% CIs. A sensitivity analysis considered disease when only visible lesions were biopsied.Results Women included in the study had well-controlled HIV infection (median CD4 count=542 cells/mm3) and all except one were on antiretroviral therapy. Among 371 participants with histopathological results, 27% (101/371) women had CIN2+ and 23% (23/101) were not detected by any index test. Sensitivity and specificity for stand-alone tests were: hrHPV, 67.3% (95% CI 57.7% to 75.7%) and 65.3% (95% CI 59.4% to 70.7%); Gynocular 51.5% (95% CI 41.9% to 61.0%) and 80.0% (95% CI 74.8% to 84.3%); and VIA 22.8% (95% CI 15.7% to 31.9%) and 92.6% (95% CI 88.8% to 95.2%), respectively. Combining tests did not improve test accuracy measures. All test accuracies improved in sensitivity analysis.Conclusion The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed.Trial registration number NCT03931083.https://bmjoncology.bmj.com/content/3/1/e000111.full |
| spellingShingle | Nicola Low Partha Basu Andreas Limacher Katayoun Taghavi Misinzo Moono Mulindi Mwanahamuntu Herbert Kapesa Albert Manasyan Julia Bohlius Marie Roumet Thamsanqa Madliwa Anne Rutjes Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia BMJ Oncology |
| title | Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia |
| title_full | Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia |
| title_fullStr | Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia |
| title_full_unstemmed | Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia |
| title_short | Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia |
| title_sort | accuracy of screening tests for cervical precancer in women living with hiv in low resource settings a paired prospective study in lusaka zambia |
| url | https://bmjoncology.bmj.com/content/3/1/e000111.full |
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