Cervical cancer screening for HIV positive women in Guyana
J. Anderson1, E. Lu2, J. Varallo2, M. Harris2, S. Kibwana2
1Johns Hopkins University School of Medicine, Baltimore, United States, 2Jhpiego, Baltimore, United States
Issues: HIV+ women are at increased risk for invasive cervical cancer (ICC). Visual inspection with acetic acid (VIA) is an inexpensive technique demonstrated as safe, feasible and acceptable; has sensitivity comparable to cytology; and was associated with a 24% decrease in ICC in a large Indian study of the general population. It also allows immediate treatment with cryotherapy in a single-visit approach. Limited data exists on performance of VIA/Cryotherapy in the setting of HIV infection.
Description: From January to December 2009, Jhpiego implemented VIA/Cryotherapy programs at 7 sites in Guyana (2 HIV sites, 5 sites serving the general population). HIV status was by self-report. Data was collected regarding VIA findings, treatment, and need for referral due to large lesion/suspicion of ICC. A chi-square test was used to compare findings among HIV+ women vs. HIV-/unknown.
Lessons Learned: January - December 2009, 5000 screened women
[Findings: VIA/Cryotherapy among 5000 women]
|All Project Sites||Number of new VIA screenings conducted||Number (%) of new clients with a VIA positive result (n=5000)||Number (%) of eligible* new VIA+ clients receiving immediate cryotherapy
(n=5000)||Number (%) of referrals for large lesions** (n=5000)|
|HIV positive||401||86 (21%)||39 (71%)||31 (36%)|
|HIV negative/status unknown||4599||815 (18%)||577 (84%)||127 (16%)|
|Total||5000||901 (18%)||616 (83%)||158 (18%)|
| || || ||*Not all women who are VIA positive are eligible for cryotherapy||** Large lesions include those that occupy more than 75% of the cervix.|
Conclusions: HIV+ women required referral for large lesions more frequently than HIV negative/unknown women (36% versus 16%, p< 0.001). This has significant program implications, including increased need for referral and/or incorporation of excisional treatment for HIV+ women - requiring additional training and resources.
Most women, regardless of HIV status, received cryotherapy during the same visit. This supports the feasibility of single-visit screening and treatment, thus reducing loss-to-follow up.
No significant association existed between HIV status and VIA positive rates. This may be because of incorrect distribution by HIV status, since this was self-reported, or that these HIV positive women have varying degrees of immune suppression and, thus, risk of dysplasia.
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