High-risk human papillomavirus testing is superior to visual inspection with acetic acid in cervical cancer screening of Kenyan and Ugandan women living with HIV

Background: The current model of screening by visual inspection with acetic acid (VIA) has not led to a reduction in cervical cancer among sub-Saharan women living with human immunodeficiency virus (HIV)/aquired immunodeficiency syndrome (AIDS)(WLWH), and screening using high-risk human papillomavirus (HR-HPV) testing has not been adequately studied in WLWH. Methods: Kenyan women aged 21 to 60 years provided self-collected vaginal swabs for HR-HPV testing (Cobas HPV® Assay), all women then underwent VIA. All WLWH (n = 120) were scheduled for cervical biopsy. Testing parameters were estimated for HR-HPV and VIA for detection of cervical intraepithelial neoplasia (CIN) grades 2 or 3, and CIN grade 3). Results: HR-HPV was detected in 49 of 120 (40.8%) WLWH. Cervical biopsy revealed CIN2/3 in 14 WLWH (11.7%) and CIN3 in 6 (5.0%). VIA was abnormal in 17 WLWH (14.2%). The sensitivities of HR-HPV testing for CIN2/3 and CIN3 detection were 78.6% and 100%, respectively, and were superior to VIA (57.1% and 50%, respectively). All 6 cases of CIN3 occurred among WLWH with a positive HR-HPV test; VIA was abnormal in 3 of these women and normal in 3. Conclusions: Future cervical cancer screening strategies for WLWH should utilize HR-HPV testing of self-collected swabs. Compared to the high sensitivity of HR-HPV testing, VIA performed poorly for CIN3 detection.