Abstract:
Objective—To determine the accuracy of visual inspection with Acetic Acid (VIA) versus
conventional Pap smear as a screening tool for cervical intraepithelial neoplasia (CIN)/cancer
among HIV-infected women.
Materials and Methods—150 HIV-infected women attending the Moi Teaching and Referral
Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy and biopsy.
VIA and Pap smears were done by nurses while colposcopy and biopsy were done by a physician.
Receiver Operating Characteristic (ROC) analysis was conducted to compare the accuracies
between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV).
Results—Among the study participants: VIA was abnormal in 55.3% (83/150, CI=47.0–63.5%);
Pap smear showed atypical squamous cells of undetermined significance (ASCUS) or worse in
43.7% (59/135, CI=35.2–52.5%) and 10% (15/150) of the Pap smears were unsatisfactory. Of the
abnormal Pap smears, 3% (2/59) had ASCUS, 7% (4/59) had ASC-high grade, 60% (35/59) had
low-grade squamous intraepithelial lesions (SIL), 29% (17/59) had high grade SIL, and 2% (1/59)
was suspicious for cervical cancer. Using cervical intraepithelial neoplasia (CIN) 2 or higher
disease on biopsy as an end point, VIA has a sensitivity of 69.6% (CI=55.1–81.0%), specificity of
51.0% (CI=41.5–60.4%), PPV of 38.6% (CI=28.8–49.3%) and NPV of 79.1% (CI=67.8–87.2%).
For conventional Pap smear, sensitivity was 52.5% (CI=42.1–71.5%), specificity 66.3%
(CI=52.0–71.2%), PPV 39.7% (CI=27.6–51.8%), and NPV 76.8% (CI=67.0–85.6%).
Conclusion—VIA is comparable to Pap smear and acceptable for screening HIV-infected
women in resource limited settings such as Western Kenya.
