ATL. Issue 3 (1st March 2014)

• Record Type: Journal Article
• Authors: Jeronimo, Jose; Bansil, Pooja; Lim, Jeanette; Peck, Roger; Paul, Proma; Amador, Juan Jose; Mirembe, Florence; Byamugisha, Josaphat; Poli, Usha Rani; Satyanarayana, Labani; Asthana, Smita
• Is Part Of: International journal of gynecological cancer. Volume 24:Issue 3(2014)
• Page Start: 576
• Page End: 585
• Publication Date: 2014-03-01
• Subjects: Cancer prevention and control -- Early detection -- Cervical cancer -- Low-resource settings -- HPV; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000000084
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objective: This study evaluates the feasibility and performance of care HPV, a novel human papillomavirus (HPV) DNA test, when used for screening women for cervical cancer in low-resource settings. Methods and Materials: Clinician-collected (cervical) and self-collected (vaginal) care HPV specimens, visual inspection with acetic acid (VIA), and Papanicolaou test were evaluated among 16, 951 eligible women in India, Nicaragua, and Uganda. Women with positive screening results received colposcopy and histologic follow-up as indicated. The positivity of each screening method was calculated overall, by site, and age. In addition, the clinical performance of each screening test was determined for detection of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2+) and CIN grade 3. Results: Moderate or severe dysplasia or cancer (taken together as CIN2+) was diagnosed in 286 women. The positivity rate ranged between 2.4% to 19.6% for vaginal care HPV, 2.9% to 20.2% for cervical care HPV, 5.5% to 34.4% for VIA, and 2.8% to 51.8% for Papanicolaou test. Cervical care HPV was the most sensitive for CIN2+ (81.5%; 95% confidence interval [CI], 76.5–85.8) and CIN grade 3 (85.3%; 95% CI, 78.6–90.6) at all sites, followed by vaginal care HPV (69.6% and 71.3%, respectively). The sensitivity of VIA ranged from 21.9% to 73.6% and Papanicolaou test from 40.7% to 73.7%. The pooled specificities of cervical care HPV, vaginal care HPV, VIA, and Papanicolaou test were 91.6%, 90.6%, 84.2%, and 87.7%, respectively. Conclusions: care HPV performed well in large multicountry demonstration studies conducted in resource-limited settings that have not previously been conducted this type of testing; its sensitivity using cervical samples or vaginal self-collected samples was better than VIA or Papanicolaou test. The feasibility of using care HPV in self-collected vaginal samples opens the possibility of increasing coverage and early detection in resource-constrained areas.