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Background: Developing countries often lack sufficient resources to use the Pap smear as a screening tool for cervical abnormalities. Visual inspection with acetic acid (VIA) is similar to Pap smears in terms of sensitivity for highgrade CIN. However, it is not very specific and adjunct testing with HPV can improve the test characteristics of VIA.
Aim: To evaluate VIA with adjunct Human Papilloma Virus (HPV) testing as an alternative to routine cervical cytology for cervical cancer screening in a low resource setting.
Methods: We conducted a cross-sectional study among the attendees of the gynecology clinics attached to our hospital. Each patient underwent three screening tests, viz., Pap smear, HPV DNA testing and VIA, sequentially. The patients who tested positive by any of these methods underwent colposcopy. Trained colposcopists, blinded to the results of initial screening tests collected biopsies from patients with colposcopic abnormalities. We tested the specimens for HPV by Polymerase Chain Reaction (PCR) using the general primers GP5+/GP6+, and checked for high risk HPV types in positive samples.
Results: The median age of participants was 38 years. Out of the 857 patients screened, 46 (5.36%), 4 (0.47%) and 13 (1.53%) tested abnormal/positive by VIA, Pap smear and HPV PCR, respectively. Sequential VIA and HPV PCR yielded a sensitivity and specificity of 80% and 93%, respectively.
Conclusions: We propose that sequential testing involving the use of VIA followed by HPV PCR could improve the test characteristics, in low-resource settings.