Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status

BMC Public Health

Annie J Sasco³  François Dabis³  Mamourou Kone¹  Raoul Moh⁶  Albert Minga⁷  Eugene Messou²  Benjamin Effi⁸  Patrick A Coffie⁴  Badian Toure¹  Didier K Ekouevi⁵  Antoine Jaquet³  Apollinaire Horo¹ 

[1]Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire

[2]CePReF, ACONDA, Abidjan, Côte d'Ivoire

[3]INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000 Bordeaux, France

[4]Clinique MTCT + Adultes, ACONDA, Abidjan, Côte d'Ivoire

[5]Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire

[6]Département d'infectiologie et de dermatologie, CHU de Treichville, Abidjan, Côte d'Ivoire

[7]Centre Médical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, Abidjan, Cote d'Ivoire

[8]Service d'Anatomo-Pathologie, CHU de Treichville, Abidjan, Côte d'Ivoire

关键词: Africa;    HIV/AIDS;    Visual inspection;    Screening;    Cervical cancer;   

Others  :  1163738
DOI  :  10.1186/1471-2458-12-237

 received in 2011-10-17, accepted in 2012-03-23,  发布年份 2012

【 摘 要 】

Background

Cervical cancer screening is not yet standard of care of women attending HIV care clinics in Africa and presents operational challenges that need to be addressed.

Methods

A cervical cancer screening program based on visual inspection methods was conducted in clinics providing antiretroviral treatment (ART) in Abidjan, Côte d'Ivoire. An itinerant team of midwives was in charge of proposing cervical cancer screening to all HIV-positive women enrolled in ART clinics as well as to HIV-negative women who were attending the Abidjan national blood donor clinic. Positively screened women were systematically referred to a colposcopic examination. A phone-based tracking procedure was implemented to reach positively screened women who did not attend the medical consultation. The association between HIV status and cervical cancer screening outcomes was estimated using a multivariate logistic model.

Results

The frequency of positive visual inspection was 9.0% (95% CI 8.0-10.0) in the 2,998 HIV-positive women and 3.9% (95% CI 2.7-5.1) in the 1,047 HIV-negative ones (p < 10^-4). In multivariate analysis, HIV infection was associated with a higher risk of positive visual inspection [OR = 2.28 (95% CI 1.61-3.23)] as well as more extensive lesions involving the endocervical canal [OR = 2.42 (95% CI 1.15-5.08)]. The use of a phone-based tracking procedure enabled a significant reduction of women not attending medical consultation after initial positive screening from 36.5% to 19.8% (p < 10^-4).

Conclusion

The higher frequency of positive visual inspection among HIV-positive women supports the need to extend cervical cancer screening program to all HIV clinics in West Africa. Women loss to follow-up after being positively screened is a major concern in cervical screening programs but yet, partly amenable to a phone tracking procedure.

【 授权许可】

   
2012 Horo et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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