Article Text
Abstract
Introduction Cervical cancer is the most common cancer among women in Liberia. Without a national screening program, Pap smear and visual inspection with acetic acid (VIA) are the most utilized screening tools. A program that compared Pap and VIA with high-risk HPV (hr-HPV) and screening for sexually transmitted infections (STIs) is reported.
Methods Percent positivity rate was calculated for all tests performed. Diagnostic test accuracy (DTA): test performance and agreement of VIA and Pap with hr-HPV was calculated as percent positive agreement (PPA) and percent negative agreement (PNA) using conventional 2x2 tables. PPA and PNA were used as surrogates for sensitivity and specificity. .
Results Among 978 participants, 507 received VIA, 342 Pap and 352 hr-HPV. Percent positivity Rates: VIA 9.27% (47/507) Pap 7.89% (27/342) hr-HPV 17.62% (62/352) Test performance and agreement compared to HPV: VIA PPA 14.06% PNA 89.7% Pap PPA 24.1% PNA 89.1% STIs positivity rates: HIV 3.4% (25/722) Gonorrhea 0.59% (2/339) Chlamydia 0.59% (2/339) Syphilis 1.8% (25/722) HPV-HIV co-infection: 13/15 (86.7%) who tested positive for syphilis were HIV+.
Conclusion/Implications hr-HPV positivity rate of 18% is the first objective assessment of HPV positivity among screened women in Liberia. Although VIA is the most cost-effective, and utilized screening method in Liberia, its percent positive agreement with hr-HPV is the lowest of the two currently used screening tests suggesting the need for increased focus on training as its use increases.