Cervical Cancer Screening among Human Immunodeficiency Virus-positive Women: A Comparison of Outcome between Visual Inspection with Acetic Acid and Papanicolaou Smear Cytology

BACKGROUND: Cervical cancer is the most common gynecological cancer in sub-Saharan Africa. Human immunodeficiency virus (HIV) infection is associated with cervical epithelial cell abnormalities. Cervical cancer screening in Nigeria is very low, and the available screening modalities have varying barriers and overall accuracies. OBJECTIVES: The objective is to compare the accuracy of papanicolaou (Pap) smear cytology and visual inspection with acetic acid (VIA) among HIV-positive women in Enugu, South-East Nigeria. METHODOLOGY: This was a cross-sectional comparative study of 438 HIV-infected women who attended the adult antiretroviral therapy clinic at University of Nigeria Teaching Hospital, Enugu, from January 2 to June 30, 2019. The eligible participants underwent Pap smear cytology, VIA, and Colposcopy. Punch biopsy was performed at the lesions (if any), 2, 6, 10, and 12 o'clock positions of the cervix. Histology of the biopsy specimens was used as the gold standard. RESULTS: Approximately 21.2%, 24.7%, and 18.7% of the participants had abnormal colposcopy and biopsy results, acetowhite reaction on VIA, and abnormal Pap smear cytology results, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of Pap smear cytology were 59.2% (48.0%-69.6%), 89.8% (86.2%-92.5%),54.9% (44.1%-65.2%), 91.3% (87.9%-93.8%), and 84.5% (80.8%-87.6%), respectively. Furthermore, the sensitivity, specificity, PPV, NPV, and overall accuracy of VIA were 64.5% (53.2%-74.3%), 83.7% (79.5%-87.2%), 45.3% (36.3-54.8%), 91.9% (88.3%-94.4%), and 80.4% (76.4%-83.8%), respectively. There was no statistical significant difference between Pap smear cytology and VIA in overall accuracy (P = 0.11). CONCLUSION: There was a high prevalence of cervical epithelial cell abnormalities among HIV-positive women in Enugu. The overall accuracy of Pap smear cytology was essentially similar to that of VIA in screening for cervical epithelial lesions. Therefore, VIA is a cheaper, more affordable, and more readily available alternative to Pap smear cytology, especially in Nigeria.