Cervical Inspection With AAVI and Cryotherapy on HPV-Diagnosed Women in Windhoek, Namibia

Abstract

In 2018, the Ministry of Health and Social Services (MoHSS) introduced acetic acid visual inspection (AAVI) screening program and treatment of cervical precancers with cryotherapy in replacement of Pap smear intervention in Namibia. The study examines the effective use of AAVI-and-cryotherapy treatment on HPV-diagnosed women. Female patients of the reproductive age (20-49 years) group visiting 2 Namibian healthcare facilities for AAVI and cryotherapy treatment were investigated using a cross-sectional approach. The SPSS and coding themes were used to analyze data received through questionnaires and face-to-face interviews from a total of 265 participants. Written informed consent was obtained from participants for treatment and for publication. Among the women that participated in the study, 151 (62%) tested HPV positive, of which 132 (53%) were referred for cryotherapy and 19 (8%) for colposcopy treatments due to Cervical Intraepithelial Neoplasia (CIN I-III) detected. Regardless of the age groups, there was significant evidence of an association between para gravida and HPV positive (χ²(6) = 24.518; P < .001) and HPV negative (χ²(18) = 137.098; P < .001). About 80% of all participants experienced unpleasant pelvic sensations during the examination, with slight abdominal pain during and after the procedure. Ten percent experienced brownish discharges from their pelvis, of which was treated during the cryotherapy treatment. These findings suggest that MoHSS should actively re-evaluate the existing policies to promote AAVI and cryotherapy treatment.

Keywords: acetic acid visual inspection (AAVI); cervical cancer; cryotherapy; human papillomavirus (HPV).

Figure 1.

Comparison between HIV status per age group. ** and * are significantly different at P < .05, respectively; ns are not significantly different (P > .05).

Figure 2.

Number of kids per participant and per age group. Erro bars show significant evidence of an association for para gravida and HPV positive (χ²(6) = 24.518; P < .001) and HPV negative (χ²(18) = 137.098; P < .001).

Figure 3.

Family history of cancer. ****; ***, ** and * are significantly different at P < .05, respectively; ns are not significantly different (P > .05).

Figure 4.

(A) Biopsy results of the Cervical Intraepithelial Neoplasia (CIN 1-111) diagnosed from HPV patients and (B) Chronic cervicitis inflammation of the cervix.