TY - JOUR

T1 - Comparison of human papillomavirus-based cervical cancer screening strategies in Tanzania among women with and without HIV

AU - Kahesa, Crispin

AU - Thomsen, Louise T.

AU - Linde, Ditte S.

AU - Mchome, Bariki

AU - Katanga, Johnson

AU - Swai, Patricia

AU - Manongi, Rachel

AU - Kjaerem, Myassa

AU - Iftner, Thomas

AU - Waldstrøm, Marianne

AU - Mwaiselage, Julius

AU - Rasch, Vibeke

AU - Kjær, Susanne K.

N1 - Funding Information: The CONCEPT study was supported by a grant from the Danish International Development Agency (DANIDA) (14‐TAN‐P02). The PROTECT study was funded by DANIDA, the University of Copenhagen and the Danish Cancer Society. The funding bodies had no influence on study objective, design, analyses, interpretation of results or the decision to submit the article for publication. Funding Information: Crispin Kahesa, Louise T. Thomsen, Ditte S. Linde, Bariki Mchome, Johnson Katanga, Patricia Swai, Rachel Manongi, Myassa Kjaerem, Marianne Waldstrøm, Julius Mwaiselage and Vibeke Rasch report no potential conflicts of interest. Susanne K. Kjær reports that she previously received research grants from Merck through the affiliating institution. Thomas Iftner reports that his hosting institution received research grants from Hologic Inc and Becton Dickinson.

PY - 2023

Y1 - 2023

N2 - Cervical cancer is the most common female cancer in Eastern Africa, and the World Health Organization (WHO) recommends human papillomavirus (HPV)-based screening as a key element to eliminate the disease. In this cross-sectional study from Tanzania, we compared nine HPV-based cervical cancer screening strategies, including HPV testing at standard cut-off; HPV testing at increased viral load cut-offs; HPV testing with partial/extended genotyping, and HPV testing with visual inspection with acetic acid (VIA). We pooled data collected during 2008 to 2009 and 2015 to 2017 from 6851 women aged 25 to 65. Cervical cytology samples were HPV tested with Hybrid Capture 2, and HPV positive samples were genotyped with INNO-LiPA Extra II. Human immunodeficiency virus (HIV) testing and VIA were done according to local standards. We calculated sensitivity, specificity, positive and negative predictive value of screening strategies, with high-grade cytological lesions as reference, separately for women with and without HIV. HPV testing at standard cut-off (1.0 relative light units [RLU]) had highest sensitivity (HIV+: 97.8%; HIV−: 91.5%), but moderate specificity (HIV+: 68.1%; HIV−: 85.7%). Increasing the cut-off for HPV positivity to higher viral loads (5.0/10.0 RLU) increased specificity (HIV+: 74.2%-76.5%; HIV−: 89.5%-91.2%), with modest sensitivity reductions (HIV+: 91.3%-95.7%; HIV−: 83.5%-87.8%). Limiting test positivity to HPV types 16/18/31/33/35/45/52/58 improved specificity while maintaining high sensitivity (HIV+: 90.2%; HIV−: 81.1%). Triage with VIA and/or partial genotyping for HPV16/18 or HPV16/18/45 had low sensitivities (≤65%). In conclusion, HPV testing alone, or HPV testing with extended genotyping or increased viral load cut-offs, may improve cervical cancer screening in Sub-Saharan Africa.

AB - Cervical cancer is the most common female cancer in Eastern Africa, and the World Health Organization (WHO) recommends human papillomavirus (HPV)-based screening as a key element to eliminate the disease. In this cross-sectional study from Tanzania, we compared nine HPV-based cervical cancer screening strategies, including HPV testing at standard cut-off; HPV testing at increased viral load cut-offs; HPV testing with partial/extended genotyping, and HPV testing with visual inspection with acetic acid (VIA). We pooled data collected during 2008 to 2009 and 2015 to 2017 from 6851 women aged 25 to 65. Cervical cytology samples were HPV tested with Hybrid Capture 2, and HPV positive samples were genotyped with INNO-LiPA Extra II. Human immunodeficiency virus (HIV) testing and VIA were done according to local standards. We calculated sensitivity, specificity, positive and negative predictive value of screening strategies, with high-grade cytological lesions as reference, separately for women with and without HIV. HPV testing at standard cut-off (1.0 relative light units [RLU]) had highest sensitivity (HIV+: 97.8%; HIV−: 91.5%), but moderate specificity (HIV+: 68.1%; HIV−: 85.7%). Increasing the cut-off for HPV positivity to higher viral loads (5.0/10.0 RLU) increased specificity (HIV+: 74.2%-76.5%; HIV−: 89.5%-91.2%), with modest sensitivity reductions (HIV+: 91.3%-95.7%; HIV−: 83.5%-87.8%). Limiting test positivity to HPV types 16/18/31/33/35/45/52/58 improved specificity while maintaining high sensitivity (HIV+: 90.2%; HIV−: 81.1%). Triage with VIA and/or partial genotyping for HPV16/18 or HPV16/18/45 had low sensitivities (≤65%). In conclusion, HPV testing alone, or HPV testing with extended genotyping or increased viral load cut-offs, may improve cervical cancer screening in Sub-Saharan Africa.

KW - Africa

KW - cervical cancer

KW - human papillomavirus

KW - prevention

KW - screening

U2 - 10.1002/ijc.34283

DO - 10.1002/ijc.34283

M3 - Journal article

C2 - 36093587

AN - SCOPUS:85138509975

VL - 152

SP - 686

EP - 696

JO - Acta - Unio Internationalis Contra Cancrum

JF - Acta - Unio Internationalis Contra Cancrum

SN - 0898-6924

IS - 4

ER -