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. 2015 Jan;19(1):7-11.
doi: 10.1097/LGT.0000000000000040.

Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa

Cynthia Firnhaber  1 , Lu Mao, Simon Levin, Mark Faesen, David A Lewis, Bridgette J Goeieman, Avril J Swarts, Ntombiyenkosi Rakhombe, Pam M Michelow, Sophie Williams, Jennifer S Smith
Affiliations
Free PMC article

Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa

Cynthia Firnhaber et al. J Low Genit Tract Dis. 2015 Jan.
Free PMC article

Abstract

Objective: To determine whether a quality assurance (QA) program using digital cervicography improved the performance of a visual inspection with acetic acid (VIA) to detect cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in HIV-infected women in Johannesburg, South Africa.

Materials and methods: Visual inspection with acetic acid was performed among HIV-infected women, aged 18 to 65 years, in Johannesburg, South Africa. Nurses received 2 weeks of training on the VIA procedure. The VIA interpretation was performed in real time. The VIA results were then photographed using a retail available digital camera. A gynecologist and medical officer reviewed the VIA digital images within 2 weeks of the procedure. Colposcopic biopsy was performed on all women with positive VIA and 25% negative VIA results. Sensitivity and specificity of VIA for the detection of CIN 2+ were compared between the nurses and physicians at the beginning and at the end of the study.

Results: Positive VIA results were found in 541 (45%) of the 1,202 participating women. The sensitivity of VIA to predict CIN 2+ was improved from 65% to 75% (p = .001) with the addition of digital cervicography and specialist review. There was no statistical difference in the sensitivity of the VIA readings when comparing the first 600 participants to the final 593 participants between the nurses (p = .613) and physicians (p = .624).

Conclusions: Quality assurance performed by specialists using digital cervicography improved the sensitivity of VIA. There was no difference in sensitivity in interpreting VIA between the beginning and the end of the study. Quality assurance should form a cornerstone of any VIA program to improve sensitivity in detecting CIN 2+ lesions.

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Conflict of interest statement

The authors have declared they have no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of visual inspection with acetic acid (VIA) of the cervix for both nurses and physicians in Johannesburg, South Africa, during the study period from 2009 to 2012.
See this image and copyright information in PMC

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References

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