TITLE:
Screen-and-Treat Approach in Secondary Prevention of Cervical Cancer among HIV-Infected Women in Faith Alive Hospital, Jos Nigeria
AUTHORS:
John Onyeji, Mercy W. Isichei, Charles U. Anyaka, Emmanuel Osayi, Olabanjo O. Ogunsola, Oluwatomiini Ademuyiwa, Abeeblahi Olafare, Oluseye Ajayi, Christian O. Isichei, Solomon A. Sagay, Perpetual C. Christopher
KEYWORDS:
Faith Alive, Women Living with HIV, VIA, Screen-and-Treat
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.4,
April
28,
2023
ABSTRACT: Background: Cervical cancer is the fourth most common cancer
among women globally, the second most common cancer in Nigeria and the
most common cause of cancer-related
death in Africa. In 2020, World Health Organization in its updated
guidelines recommended cervical cancer screening using HPV DNA, HPV mRNA tests
and subsequent treatment as appropriate. However, in resource-poor settings,
Visual Inspections with Acetic Acid (VIA), Lugol’s Iodine (VILI) and subsequent
treatment of precancerous lesions with thermal ablation remain the practical
approaches. Objectives: To determine the prevalence
of precancerous cervical lesions and associated risk factors among Women Living
with HIV (WLHIV). Methods: A retrospective study on
sexually active WLHIV aged 16 - 55 years screened for cervical cancer using VIA and
VILI within 16 months period in Faith Alive Hospital Jos. Data were analyzed
using IBM-SPSS 26. Sociodemographic characteristics of the study participants
and the screening results were presented in frequency tables, and logistic regression was performed to determine risk factors of
pre-cancerous lesions. Results: 1113 women were screened for
cervical cancer using VIA/VILI. 994 (89.3%) were negative, 101 (9.1%) were
positive for precancerous lesions, and 18 (1.6%) were suspicious of cervical
cancer. The mean age of clients with pre-cancerous lesions was 41.32 ± 9.89 years. A higher
positivity yield (69.4%) was found in ages between 36 and ≥55 years while a less positivity yield (30.6%) was found in age’s
≤ 35 years. History of STI had 1.64 fold risk association
with precancerous lesions. Conclusion: Our study demonstrated a high
prevalence of precancerous cervical lesions among WLHIV; bimodal age
distribution for cancer-suspicious lesions and risk associated with STI. Thus, a “screen-and-treat”
approach to cervical cancer prevention by VIA
and thermal ablation in resource-poor settings should be undertaken until
widespread HPV testing to triage clients is feasible.