A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria

Abstract

Objective: Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.

Methods: In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.

Results: Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.

Conclusion: In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.

Figure 1

Percent of VIA examinations with inadequate or abnormal results, by health worker, by age group Note: SCJ = squamocolumnar junction. N indicates number of VIA examinations for each provider given patient age. Fisher’s exact test of significance: P<.01 for age 15–29, P=.21 for age 30–49, and P<.01 for age 50–99. For tests of significance, VIA results of positive and suspicious cancer are combined and excludes women with “SCJ not visible.”