Abstract 872P
Background
Cancer of the cervix uteri is the most preventable cancer and yet the second most frequent cancer in women worldwide, with an estimated 500 000 incident cases and 273 000 deaths per year. Approximately 80% of cases occur in developing countries, where cervical cancer is the leading cause of cancer death in women. Human immune deficiency virus (HIV) infection has a compounding effect on the progressive potential of premalignant lesions of the cervix to frank malignancy.
Methods
The study was a cross-sectional study. The study population comprised 348 HIV positive women attending the clinic at FMC Yenagoa. The sample was obtained from all consecutive eligible women attending the clinic during the study period. Each participant underwent VIA, cervical cytology and colposcopy and biopsy.
Results
Three hundred and forty-eight (348) respondents were recruited into this study. Twenty-two per cent had biopsy confirmed CIN2+ (CIN2, CIN3, CIS). The assessment of the diagnostic accuracy of the VIA, colposcopy and Pap smear tests as screening tests (using biopsy as the gold standard for diagnosis) showed that Pap smear tests with a sensitivity and specificity results of 43.8% & 98.4% respectively was the best performing screening tool. Colposcopy and VIA also performed fairly well with sensitivity and specificity of 43.8% & 86.0% respectively (for VIA smear test) and 60.3% and 79.9% respectively (for colposcopy). Combining VIA and Pap smear test also gave high accuracy of 32.9% and 100% for sensitivity and specificity respectively. Cost effectiveness Analysis (CEA) revealed that using the natural health outcome of ‘number of cases identified correctly’ VIA was the most cost – effective method of screening for precancer of the cervix in the population under review followed by colposcopy and Pap smear test with $18.68 per case, $73.45 per case and $133.57 respectively.
Conclusions
The high prevalence of CIN2+ in this population of HIV positive patients is an indication for a structured screening service. Thus, the combination of VIA and Pap smear can be recommended as a sequential screening tool where a screen and treat policy is adopted in high-risk clients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Nigerian Content Development and Monitoring Board (NCDMB).
Disclosure
All authors have declared no conflicts of interest.