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 3. Demographic and clinical predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in HIV-infected women screened for cervical cancer with two different screening strategies, Kisumu, Kenya, October 2007 to October 2010

Predictor Total n VIAa (n = 2266)
VIA/VILIb (n  = 1 058)
Negative (n = 1650) Positive (n = 616) ORc 95% CI Negative (n = 814) Positive (n = 244) ORc 95% CI
Age (years), mean, (SD) 35.5 (8.7) 33.5  (6.8) 0.97 0.96–0.98 36.7 (9.1) 32.9 (6.7) 0.94 0.92–0.96
Relationship status, no., (%) 1539
No current partner 317 (48.9) 136 (46.7) 1.00 188 (47.2) 71 (50.7) 1.00
At least one current partner 331 (51.1) 155 (53.3) 0.92 0.69–1.23 206 (52.3) 69 (49.3) 0.83 0.56–1.23
Reproductive history, no., (%) 900
Pregnancies 3.55 (2.4) 3.14 (2.0) 0.99 0.91–1.08 2.7 (1.5) 2.2 (1.5) 1.02 0.50–2.09
Hormonal contraceptive used 2966
Oral 318 (20.5) 175 (30.6) 1.55 1.24–1.93 92 (17.8) 59 (30.3) 1.62 1.09–2.39
Injectable 309 (19.9) 130 (22.0) 1.01 0.80–1.28 24 (4.7) 8 (4.1) 0.68 0.30–1.57
Implant 2 (0.2) 16 (2.8) 20.1 4.6–88.0 6 (1.2) 8 (4.1) 2.83 0.95–8.41
Intrauterine device in placee 11 (0.7) 4 (0.7) 0.99 0.31–3.12 7 (1.4) 2 (1.0) 0.88 0.18–4.36
HIV-related parameters
Months since diagnosis of HIV infection, mean, (SD) 11.2 (11.9) 14.5 (17.0) 1.02 1.01–1.03 16.8 (15.6) 14.2 (15.3) 0.99 0.98–1.00
WHO stage, no., (%) 3326
      1 336 (21.0) 152 (25.2) 1.00 152 (20.8) 40 (17.9) 1.00
      2 419 (25.6) 163 (27.0) 0.92 0.70–1.20 190 (26.0) 57 (25.5) 1.30 0.81–2.06
      3 600 (36.7) 211 (34.9) 0.87 0.68–1.13 339 (46.4) 112 (50.0) 1.49 0.98–2.26
      4 279 (17.1) 78 (12.9) 0.69 0.50–0.95 49 (6.7) 15 (6.7) 1.35 0.68–2.68
CD4+ cell nadir (cells/µL), no., (%) 2841
     < 200 407 (28.6) 168 (31.5) 1.00 166 (29.2) 69 (34.5) 1.00
     201–350 468 (32.8) 169 (31.7) 0.86 0.67–1.11 168 29.5) 64 (32.0) 0.91 0.60–1.37
     351–500 286 (20.1) 97 (18.2) 0.79 0.59–1.06 122 (21.4) 32 (16.0) 0.64 0.39–1.04
     > 500 264 (18.5) 100 (18.7) 0.85 0.63–1.14 113 (19.9) 35 (17.5) 0.69 0.43–1.12
On HAART, no., (%) 3460 988 (59.9) 341 (55.4) 0.89 0.73–1.07 281 (34.5) 96 (39.3) 1.29 0.95–1.74
Months on HAART, mean (SD) 11.0 (7.4) 9.2 (7.3) 0.97 0.95–0.98 4.8 (6.9) 5.6 (7.1) 1.02 0.99–1.05
On first-line regimen, no. (%) 1769 950 (96.2) 321 (94.1) 0.57 0.32–0.99 276 (98.2) 93 (96.9) 0.64 0.15–2.83
Months in care before HAART initiation, mean (SD) 4.5  (8.0) 4.2 (7.9) 0.99 0.98–1.01 15.3 (16.3) 11.7 (15.6) 0.99 0.97–1.01
CCSP performed at enrolment in HIV care, no. (%) 3460 75 (4.5) 31 (5.2) 1.15 0.75–1.77 98 (12.0) 35 (14.3) 1.20 0.79–1.83

CCSP, cervical cancer screening and prevention; CI, confidence interval; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; OR, odds ratio; 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+ (moderate dysplasia or worse).

c The ORs of all predictors (except age) are adjusted for age at screening test.

d Within the 90 days preceding the screening visit.

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.

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 138 women: 95 with cervicitis, 41 with unsatisfactory screening results and 2 with missing demographic information.