Gynecology Division, Geneva University Hospitals, Geneva, Switzerland.
Saint Damien Health Center, Ambanja, Madagascar.
PLoS One. 2019 Aug 13;14(8):e0220632. doi: 10.1371/journal.pone.0220632. eCollection 2019.
To assess triage compliance and the effect of the time from screening to triage on follow-up among HPV-positive women.
We recruited 1232 women in a screening campaign in Madagascar from February to October 2015. In the first period (February-May), HPV tests were performed remotely using the cobas test. In the second period (May-October), testing was performed on-site using the Xpert HPV assay. HPV-positive women were invited for triage with visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). Systematic biopsy and endocervical brushing were performed on all HPV-positive women for quality control. Three groups were defined according to time from HPV testing to triage invitation for HPV-positive women-Group I: delayed (> 3 months), Group II: prompt (24-48 hours), and Group III: immediate (< 24 hours).
A total 1232 self-sampled HPV tests were performed in the study period (496 in Group I, 512 in Group II, and 224 in Group III). Participants' mean age was 43.2 ± 9.3 years. Mean time from screening to VIA/VILI testing was 103.5 ± 43.6 days. Overall HPV prevalence was 28.0%. HPV prevalence was 27.2% in Group I (cobas test), 29.2% in Group 2 (Xpert test), and 26,7% in Group III (Xpert test). The VIA/VILI compliance rate was 77.8% for Group I, 82.7% for Group II, and 95.0% for Group III. Of women undergoing VIA/VILI, 56.3% in Group I and 43.5% in Groups II/III had positive results. Prevalence of cervical intraepithelial neoplasia grade 2 or worse among HPV-positive women was 9.8% for Group I and 6.8% for Groups II/III. Non-adherence was higher among rural women, uneducated women, and women in Group I.
HPV-positive women with immediate VIA/VILI triage invitation had the best triage compliance. A single-day test and triage strategy is preferred for low-resource settings.
评估分流符合率以及从筛查到分流的时间对 HPV 阳性女性随访的影响。
我们于 2015 年 2 月至 10 月在马达加斯加的一次筛查活动中招募了 1232 名女性。在第一阶段（2 月至 5 月），使用 cobas 试验远程进行 HPV 检测。在第二阶段（5 月至 10 月），现场使用 Xpert HPV 检测进行检测。HPV 阳性女性受邀进行醋酸视觉检查（VIA）和卢戈氏碘液检查（VILI）分流。所有 HPV 阳性女性均进行系统活检和宫颈刷取，以进行质量控制。根据 HPV 阳性女性从 HPV 检测到分流邀请的时间，将她们分为三组：I 组：延迟（>3 个月），II 组：及时（24-48 小时），III 组：即刻（<24 小时）。
在研究期间共进行了 1232 次自我采样 HPV 检测（I 组 496 次，II 组 512 次，III 组 224 次）。参与者的平均年龄为 43.2±9.3 岁。从筛查到 VIA/VILI 检测的平均时间为 103.5±43.6 天。总体 HPV 流行率为 28.0%。I 组（cobas 检测）HPV 流行率为 27.2%，II 组（Xpert 检测）为 29.2%，III 组（Xpert 检测）为 26.7%。I 组 VIA/VILI 符合率为 77.8%，II 组为 82.7%，III 组为 95.0%。在接受 VIA/VILI 检查的女性中，I 组 56.3%和 II/III 组 43.5%的结果为阳性。HPV 阳性女性中宫颈上皮内瘤变 2 级或更高级别病变的发生率为 I 组 9.8%，II/III 组 6.8%。农村妇女、未受教育妇女和 I 组妇女的不依从率较高。
即刻进行 VIA/VILI 分流邀请的 HPV 阳性女性具有最佳的分流依从性。对于资源匮乏的地区，最好采用单日检测和分流策略。
