Odafe Solomon, Torpey Kwasi, Khamofu Hadiza, Oladele Edward, Adedokun Oluwasanmi, Chabikuli Otto, Mukaddas Halima, Usman Yelwa, Aiyenigba Bolatito, Okoye Macpaul
Department of Prevention, Care and Treatment, FHI 360, Garki, Nigeria.
Niger Med J. 2013 May;54(3):176-84. doi: 10.4103/0300-1652.114590.
Human immunodeficiency virus positive (HIV+) women have a higher risk of developing invasive cervical cancer compared with uninfected women. This study aims to document programmatic experience of integrating cervical cancer screening using Visual Inspection and Acetic Acid (VIA) into HIV care as well as to describe patients' characteristics associated with positive VIA findings amongst HIV+ women.
A cross-sectional study analysed routine service data collected at the antiretroviral therapy (ART) and cervical cancer screening services. Our program integrated screening for cervical cancer using VIA technique to HIV care and treatment services through a combination of stakeholder engagement, capacity building for health workers, creating a bi-directional referral between HIV and reproductive health (RH) services and provider initiated counselling and screening for cervical cancer. Information on patients' baseline and clinical characteristics were captured using an electronic medical records system and then exported to Statistical Package for the Social Sciences (SPSS). Logistic regression model was used to estimate factors that influence VIA results.
A total of 834 HIV+ women were offered VIA screening between April 2010 and April 2011, and 805 (96.5%) accepted it. Complete data was available for 802 (96.2%) women. The mean age at screening and first sexual contact were 32.0 (SD 6.6) and 18.8 (SD 3.5) years, respectively. VIA was positive in 52 (6.5%) women while 199 (24.8%) had a sexually transmitted infection (STI). Of the 199 who had a STI, eight (4.0%) had genital ulcer syndrome, 30 (15.1%) had lower abdominal pain syndrome and 161 (80.9%) had vaginal discharge syndrome. Presence of lower abdominal pain syndrome was found to be a significant predictor of a positive VIA result (P = 0.001). Women with lower abdominal pain syndrome appeared to be more likely (OR 47.9, 95% CI: 4.8-480.4, P = 0.001) to have a positive VIA result.
The high burden of both HIV and cervical cancer in developing countries makes it a necessity for integrating services that offer early detection and treatment for both diseases. The findings from our study suggest that integrating VIA screening into the package of care offered to HIV+ women is feasible and acceptable.
与未感染的女性相比，人类免疫缺陷病毒阳性（HIV+）女性患浸润性宫颈癌的风险更高。本研究旨在记录将醋酸肉眼观察法（VIA）宫颈癌筛查纳入HIV护理的项目经验，并描述HIV+女性中与VIA阳性结果相关的患者特征。
一项横断面研究分析了在抗逆转录病毒治疗（ART）和宫颈癌筛查服务中收集的常规服务数据。我们的项目通过利益相关者参与、卫生工作者能力建设、在HIV与生殖健康（RH）服务之间建立双向转诊以及由提供者发起宫颈癌咨询和筛查等方式，将使用VIA技术的宫颈癌筛查纳入HIV护理和治疗服务。使用电子病历系统收集患者的基线和临床特征信息，然后导出到社会科学统计软件包（SPSS）。采用逻辑回归模型估计影响VIA结果的因素。
在2010年4月至2011年4月期间，共有834名HIV+女性接受了VIA筛查，其中805名（96.5%）接受了筛查。802名（96.2%）女性有完整数据。筛查时的平均年龄和首次性接触年龄分别为32.0（标准差6.6）岁和18.8（标准差3.5）岁。52名（6.5%）女性VIA结果为阳性，199名（24.8%）患有性传播感染（STI）。在199名患有STI的女性中，8名（4.0%）患有生殖器溃疡综合征，30名（15.1%）患有下腹痛综合征，161名（80.9%）患有阴道分泌物综合征。发现下腹痛综合征的存在是VIA结果阳性的一个重要预测因素（P = 0.001）。患有下腹痛综合征的女性似乎更有可能（比值比47.9，95%置信区间：4.8 - 480.4，P = 0.001）VIA结果为阳性。
发展中国家HIV和宫颈癌的高负担使得整合为这两种疾病提供早期检测和治疗的服务成为必要。我们研究的结果表明，将VIA筛查纳入为HIV+女性提供的护理套餐是可行且可接受的。
