Bulletin of the World Health Organization

A comparison of two visual inspection methods for cervical cancer screening among HIV-infected women in Kenya

Megan J Huchko, Jennifer Sneden, Hannah H Leslie, Naila Abdulrahim, May Maloba, Elizabeth Bukusi & Craig R Cohen

Volume 92, Number 3, March 2014, 195-203

Table 1. Baseline demographic and clinical characteristics of HIV-infected women screened for cervical cancer with two different screening strategies, Kisumu, Kenya, October 2007 to October 2010

Characteristic Total n VIAa (n = 2336) VIA/VILIb (n  = 1124) P
Age (years), mean, (SD) 34.9 (8.2) 35.7 (8.7) 0.01
Education, no., (%) 1565 0.65
Attended primary school 578 (57.8) 332 (58.8)
Attended secondary school 327 (32.7) 184 (32.6)
Attended university 95 (9.5) 49 (8.7)
Relationship status,c no., (%) 1539 0.78
No current partner 471 (48.4) 269 (47.6)
At least one current partner 503 (51.6) 296 (52.4)
Reproductive history, no., (SD) 900 < 0.01
Pregnancies 3.4 (2.3) 2.2 (1.5)
Hormonal contraceptive use,d no., (%) 2966 < 0.01
Oral 505 (23.0) 163 (21.5) 0.37
Injectable 459 (20.7) 32 (4.2) < 0.001
Implant 18 (0.8) 14 (1.8) 0.02
Intrauterine device in placee 16 (0.7) 9 (1.2) 0.24
HIV-related parameters
Months since diagnosis of HIV infection, mean, (SD) 12.4 (14.0) 15.9 (15.4) < 0.01
WHO stage of HIV infection, no., (%) 3326 0.10
     1 508 (22.2) 210 (21.0)
     2 598 (26.0) 267 (26.2)
     3 835 (36.2) 473 (46.5)
     4 367 (15.9) 68 (6.9)
CD4+ cell nadir (cells/µL), no., (%) 2841 0.77
     < 200 593 (29.4) 250 (30.4)
     201–350 655 (32.5) 246 (29.9)
     351–500 395 (19.6) 164 (19.9)
     > 500 375 (18.6) 163 (19.8)
On HAART, no., (%) 3460 1367 (58.5) 402 (35.8) < 0.01
Months on HAART, mean, (SD) 10.5 (7.4) 5.0 (6.8) < 0.01
On first-line HAART regimen,f no. (%) 1769 1308 (95.7) 394 (98.0) 0.04
Months in care before HAART initiation, mean, (SD) 4.5 (8.0) 14.4 (12.8) < 0.01
CCSP performed at FACES enrolment visit, no., (%) 3460 109 (4.7) 144 (12.8) < 0.01

CCSP, cervical cancer screening and prevention; CIN 2+, cervical intraepithelial neoplasia grade 2 (moderate dysplasia) or worse; FACES, Family AIDS Care and Education Services; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; SD, standard deviation; WHO, World Health Organization.

a Cervical visual inspection with acetic acid.

b VIA, followed by visual inspection with Lugol’s iodine if VIA was positive for CIN 2+.

c Women were defined as having a current partner if they reported living with a spouse or unmarried partner.

d Within the 90 days preceding the screening visit. Women may have been using more than one method.

e At the time of this analysis, levonorgestrol-releasing intrauterine devices (IUDs) were not available in western Kenya. Therefore, IUDs are not classified under hormonal contraception.

f First-line HAART regimens consisted of a triple drug combination of either zidovudine or stavudine + lamivudine + either nevirapine or efaviranz.

Note: Row totals reflect missing data. The sum of the percentages for each predictor may not equal 100 due to rounding. VIA was performed on 2338 women and VIA/VILI on 1124 women. Excluded from this table are 2 women with missing demographic information.