Comparing Results of VIA Testing for Cervical Cancer Screening with HPV DNA Testing at a Tertiary Care Centre

Abstract Background: Cervical cancer ranks fourth among the most commonly diagnosed cancers as well as the fourth leading cause of cancer mortality in women globally. The major risk factor for cervical cancer is persistent infection with high risk (HR) human papilloma virus (HPV) and 83.2% of invasive cervical cancers are attributed to HPVs 16 or 181. In 2018, World Health Organization has called for a global action towards elimination of cervical cancer (a threshold of 4 per 100,000 women-year) and set 90-70-90 targets to be achieved by 20302. The challenges and difficulties in implementing cytology screening in Low resource countries have stimulated the search for alternative methods of screening such as HPV Testing, visual inspection with acetic acid (VIA) or with Lugol's iodine - which provide result in less than 5 minutes, eliminate loss to follow up and give treatment in the same visit. Methods: A hospital based cross sectional study was conducted in the Gynecology OPD of PBM Hospital, Bikaner. 118 women aged 19-60 years presenting with complaints such as intermenstrual bleeding, postmenopausal bleeding, increased or foul-smelling vaginal discharge etc were included. A questionnaire was administered containing general information, clinical findings at pelvic evaluation. They then underwent Visual Testing with Acetic Acid (VIA), HPV testing and histo-pathology. Appropriate statistical tests were used to compare the outcome between the sub-groups. Results: On comparing VIA with HPV-DNA the sensitivity was 62.5%, specificity was 83.64%, PPV was 21.7% and NPV was 96.8%. The p-value was 0.001. VIA identified over half of HPV-DNA positive women and was highly reliable in ruling out HPV infection. Compared with Histopathology, its sensitivity was 100%, specificity was 82.61%, PPV was 13% and NPV was 100%. The p-value was <0.001. VIA detected all biopsy-confirmed disease cases, making it an excellent rule-out tool, despite many false positives. Conclusions: VIA testing reliably rules out HPV infection, reflecting its utility as a screening test in early detection of high-risk cases in low and middle income countries.