Prevalence and factors associated with positive visual inspection with acetic acid among women with high risk human papilloma virus at Mulago Hospital

Abstract

Introduction: Cervical cancer is the leading cause of cancer related death in Uganda among both women and men. Currently, the World Health Organization (WHO) recommends screening with Human Papilloma Virus (HPV) testing over both visual inspection with acetic acid (VIA) and cytology. Although HPV tests exhibit a higher degree of reproducibility, HPV testing alone has a high number of false positives due to its low specificity for actual disease. This may require additional triage tests to specifically identify women that need treatment. VIA is a potential triage test. There is need to understand the prevalence of VIA positive lesions and associated factors among women who test positive for high risk HPV (hrHPV). Objective: To determine the prevalence of VIA positive lesions and associated factors among hrHPV positive women and the factors associated at Mulago National Referral Hospital. Methods: We conducted a cross sectional study among hrHPV positive women aged 25-50 years participating in a larger study that explored strategies for triage for human papilloma virus DNA positive women. After consenting the women, we recruited 175 hrHPV positive women as they returned for treatment. We performed a VIA test, collected socio-clinical characteristics using an interviewer administered questionnaire. Results: Between December 2019 and March 2018, 175 participants were recruited and tested with VIA. The mean age was 35 (±7.73 SD) years, participants with age at sexual debut less than 16 years were 36.6% of the study participants and all the women had not been previously treated for cervical cancer. The prevalence of positive visual inspection with acetic acid amongst the 175 participants was 21.47 %( n=35). In multivariate analysis, age between 36 and 40 years was significantly associated with VIA positive lesions. Conclusion: The prevalence of VIA positive lesions among women with hrHPV was 21.47%. This is higher than the prevalence in an unscreened population. Participants aged between 35 and 40 years were more likely to have VIA positive lesions. Recommendation: VIA is a viable triage method for women with VIA positive lesions among hrHPV positive women. This can be applied to women aged 35 years and above because of this the age group that is more likely to have positive lesions.