PerformanceofcareHPV,hybridcapture2andvisualinspectionwithaceticacidfordetectionofhigh-gradecervicallesioninTanzania:A cross-sectionalstudy

Johnson KatangaID1,2*, Susanne K. Kjaer 3,4, Rachel Manongi 5, Chun Sen Wu 6,7, ThomasIftner 8, Marianne Waldstrom 9, Andrea B.Pembe 2, Julius Mwaiselage 1,Vibeke Rasch 6,7
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Toexamine the test performance of  care HPV, Hybrid Capture2 (HC2) and visualin spection  with acetic acid (VIA) for detection of cytologically diagnosed high-grade cervical lesionsor cancer (HSIL+). Design Cross-sectional study. Setting Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Center (KCMC), Tanzania. Population

Women attending routine cervical cancer screening.


Weenrolled 4080 women (25–60years)  in the study.The women were interviewed on life-stylehabits, and tested for HIV.A cervical specimen for care HPV testing (performed at ORCI and KCMC), and a liquid-based cytology sample for HPVDNA detection using HC2 (performed at Tuebingen University Hospital,Germany) and for cytology assessment (per-formed at Vejle Hospital, Denmark) were obtained at a gynecological examination

Subsequently, VIA was performed. With cytology as gold standard, the sensitivity and speci-ficity of care HPV, HC2, and VIA for detection of HSIL+were calculated. Results A l together, 23.6% had a positive care HPV test,19.1% hadpositive HC2 test, and 6.3% had a positive VIA test. The sensitivity/specificity was 88.9%/ 78.9% forcare HPVand 91.1%/83.7%, for HC2.VIA showed a low sensitivityof 31.1%buta high specificity (94.6%) fordetectionof HSIL+.Thesensitivity of care HPV, HC2 and VIA was higher among younger women, and among HIV positive women. VIA triage of care HPV positive women improved specificity, but sensitivity dropped to 27%.



Our results confirm the low sensitivity of VIA for detection of HSIL+and further document that care HPV test is promising as a primary screening method for cervical-cancer preven-tionin low-resource regions.A suitable triage test has to be identified.