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Cervical cancer is one of the most common malignancies among women in low resource setting. The objective of this study was to assess the acceptability of prenatal cervical cancer screening using visual inspection with acetic acid (VIA) in a low resource setting. This was a cross-sectional study conducted at Moi Teaching and Referral Hospital. Over a period of 12 months, we enrolled 331 women who were attending antenatal care clinic with a gestation of age of less than 22 weeks. We screened them for cervical cancer by applying 5% acetic acid to the cervix (VIA Method). Visualization of aceto-white lesions was interpreted as a positive VIA test. A cervicography was obtained for independent review by two clinicians. A repeat VIA test or colposcopy and biopsy were recommended at 6 weeks postpartum for those with a positive VIA test. Mean gestational age was 16 weeks. Seventy five percent of participants (n = 247) had used contraceptives, 31.1% (n = 103) had previously been screened for cervical cancer and 9.1% (n = 14) were HIV positive. The study clinician detected 11.3% VIA positive while first and second independent reviewers reported 22.5% and 7.7% VIA-positive results, respectively. About 85.7% of the participants did not experience any immediate adverse reaction as a result of the procedure. However, 3.8%, 38.4% and 0.7% experienced pain, burning sensation and bleeding respectively. Overall, 98.4% (n = 306) indicated that they would recommend the test, and 99% (n = 307) indicated that they would return for a repeat test 6 weeks postpartum. HIV status had no influence on VIA-positive rates (p = 0.909). The rate of VIA positive was 13.8% among the pregnant women. It is acceptable to use VIA to screen pregnant women for cervical cancer.

Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect posttreatment cervical disease in HIV-infected women in Kenya.This is a prospective cohort study.At least 6 months following cryotherapy, 517 HIV-infected women were evaluated concurrently with visual inspection with acetic acid (VIA), papanicolaou (Pap) smear, and high-risk human papillomavirus (HR-HPV) testing. Women positive by any test (≥low-grade squamous intraepithelial lesion for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation [and 174 assumed to be truly negative for cervical intraepithelial neoplasia (CIN)2+ after testing negative by all three tests], the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in posttreatment follow-up.The median age of women was 35 years, 68% were WHO stage 1-2, with a median CD4 cell count of 410 cells/μl, and 87% were on combination antiretroviral therapy. At a median of 6.3 months posttreatment, 64% had an abnormal screen by VIA, Pap, and/or HR-HPV. Among women with histological confirmation, 72 (30%) had persistent/recurrent CIN2+. As single tests, Pap correctly classified the most cases (83%) and had the highest specificity [91% (88 and 95%); sensitivity 44% (35 and 53%)], whereas HR-HPV had the highest sensitivity [85% (75 and 96%); specificity 54% (49 and 58%)]. VIA was not sensitive [27% (18 and 36%)] for the detection of posttreatment CIN2+ [specificity 82% (79 and 86%)].With the goal to minimize the number of false negatives (e.g. not miss CIN2+ posttreatment) in this population that is high-risk due to both prior cervical disease and HIV infection, HR-HPV-based algorithms are recommended.

Background Cervical cancer is common among Kenyan women and is caused by oncogenic human papillomaviruses (HR-HPV). Identification of factors that increase HR-HPV persistence is critically important. Kenyan women exposed to aflatoxin have an increased risk of cervical HR-HPV detection. This analysis was performed to examine associations between aflatoxin and HR-HPV persistence. Methods Kenyan women were enrolled in a prospective study. The analytical cohort for this analysis included 67 HIV-uninfected women (mean age 34 years) who completed at least two of three annual study visits and had an available blood sample. Plasma aflatoxin was detected using ultra-high pressure liquid chromatography (UHPLC)-isotope dilution mass spectrometry. Annual cervical swabs were tested for HPV (Roche Linear Array). Ordinal logistic regression models were fitted to examine associations of aflatoxin and HPV persistence. Results Aflatoxin was detected in 59.7% of women and was associated with higher risk of persistent detection of any HPV type (OR = 3.03, 95%CI = 1.08-8.55, P = 0.036), HR-HPV types (OR = 3.63, 95%CI = 1.30-10.13, P = 0.014), and HR-HPV types not included in the 9-valent HPV vaccine (OR = 4.46, 95%CI = 1.13-17.58, P = 0.032). Conclusions Aflatoxin detection was associated with increased risk of HR-HPV persistence in Kenyan women. Further studies are needed to determine if aflatoxin synergistically interacts with HR-HPV to increase cervical cancer risk.