Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa

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dc.contributor.authorFirnhaber, Cynthiaen_ZA
dc.contributor.authorMayisela, Nomthaen_ZA
dc.contributor.authorMao, Luen_ZA
dc.contributor.authorWilliams, Sophieen_ZA
dc.contributor.authorSwarts, Avrilen_ZA
dc.contributor.authorFaesen, Marken_ZA
dc.contributor.authorLevin, Simonen_ZA
dc.contributor.authorMichelow, Pamen_ZA
dc.contributor.authorOmar, Tanvieren_ZA
dc.contributor.authorHudgens, Michael Gen_ZA
dc.date.accessioned2015-11-18T07:05:00Z
dc.date.available2015-11-18T07:05:00Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: HIV-infected women are at increased risk for developing cervical cancer. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. We evaluated three cervical cancer screening methods to detect cervical intraepithelial neoplasia grade 2 and above (CIN 2+) in HIV-infected women in South Africa; Pap smear, visual inspection with 5% acetic acid (VIA) and human papillomavirus detection (HPV). METHODS: HIV-infected women aged 18-65 were recruited in Johannesburg. A cross-sectional study evaluating three screening methods for the detection of the histologically-defined gold standard CIN-2 + was performed. Women were screened for cervical abnormalities with the Digene HC2 assay (HPV), Pap smear and VIA. VIA was performed by clinic nurses, digital photographs taken and then later reviewed by specialist physicians. The sensitivity, specificity and predictive valves for CIN-2 + were calculated using maximum likelihood estimators. RESULTS: 1,202 HIV-infected women participated, with a median age of 38 years and CD4 counts of 394 cells/mm 3 . One third of women had a high grade lesion on cytology. VIA and HPV were positive in 45% and 61% of women respectively. Estimated sensitivity/specificity for HPV, Pap smear and VIA for CIN 2+ was 92%/51.4%, 75.8%/83.4% and 65.4/68.5% (nurse reading), respectively. Sensitivities were similar, and specificities appeared significantly lower for the HPV test, cytology and VIA among women with CD4 counts ≤200 cells/mm 3 as compared to CD4 counts >350 cells/mm 3 . CONCLUSIONS: Although HPV was the most sensitive screening method for detecting CIN 2+, it was less specific than conventional cytology and VIA with digital imaging review. Screening programs may need to be individualized in context of the resources and capacity in each area.en_ZA
dc.identifier.apacitationFirnhaber, C., Mayisela, N., Mao, L., Williams, S., Swarts, A., Faesen, M., ... Hudgens, M. G. (2013). Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15114en_ZA
dc.identifier.chicagocitationFirnhaber, Cynthia, Nomtha Mayisela, Lu Mao, Sophie Williams, Avril Swarts, Mark Faesen, Simon Levin, Pam Michelow, Tanvier Omar, and Michael G Hudgens "Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15114en_ZA
dc.identifier.citationFirnhaber, C., Mayisela, N., Mao, L., Williams, S., Swarts, A., Faesen, M., ... & Smith, J. S. (2013). Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa. PloS one, 8(1), e53494. doi:10.1371/journal.pone.0053494en_ZA
dc.identifier.ris TY - Journal Article AU - Firnhaber, Cynthia AU - Mayisela, Nomtha AU - Mao, Lu AU - Williams, Sophie AU - Swarts, Avril AU - Faesen, Mark AU - Levin, Simon AU - Michelow, Pam AU - Omar, Tanvier AU - Hudgens, Michael G AB - BACKGROUND: HIV-infected women are at increased risk for developing cervical cancer. Women living in resource-limited countries are especially at risk due to poor access to cervical cancer screening and treatment. We evaluated three cervical cancer screening methods to detect cervical intraepithelial neoplasia grade 2 and above (CIN 2+) in HIV-infected women in South Africa; Pap smear, visual inspection with 5% acetic acid (VIA) and human papillomavirus detection (HPV). METHODS: HIV-infected women aged 18-65 were recruited in Johannesburg. A cross-sectional study evaluating three screening methods for the detection of the histologically-defined gold standard CIN-2 + was performed. Women were screened for cervical abnormalities with the Digene HC2 assay (HPV), Pap smear and VIA. VIA was performed by clinic nurses, digital photographs taken and then later reviewed by specialist physicians. The sensitivity, specificity and predictive valves for CIN-2 + were calculated using maximum likelihood estimators. RESULTS: 1,202 HIV-infected women participated, with a median age of 38 years and CD4 counts of 394 cells/mm 3 . One third of women had a high grade lesion on cytology. VIA and HPV were positive in 45% and 61% of women respectively. Estimated sensitivity/specificity for HPV, Pap smear and VIA for CIN 2+ was 92%/51.4%, 75.8%/83.4% and 65.4/68.5% (nurse reading), respectively. Sensitivities were similar, and specificities appeared significantly lower for the HPV test, cytology and VIA among women with CD4 counts ≤200 cells/mm 3 as compared to CD4 counts >350 cells/mm 3 . CONCLUSIONS: Although HPV was the most sensitive screening method for detecting CIN 2+, it was less specific than conventional cytology and VIA with digital imaging review. Screening programs may need to be individualized in context of the resources and capacity in each area. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0053494 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa TI - Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa UR - http://hdl.handle.net/11427/15114 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15114
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0053494
dc.identifier.vancouvercitationFirnhaber C, Mayisela N, Mao L, Williams S, Swarts A, Faesen M, et al. Validation of cervical cancer screening methods in HIV positive women from Johannesburg South Africa. PLoS One. 2013; http://hdl.handle.net/11427/15114.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Virologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Firnhaber et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherCytologyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherCancer screeningen_ZA
dc.subject.otherNursesen_ZA
dc.subject.otherCervical canceren_ZA
dc.subject.otherHistologyen_ZA
dc.subject.otherHuman papillomavirusen_ZA
dc.titleValidation of cervical cancer screening methods in HIV positive women from Johannesburg South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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