A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women.
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2015
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Visual inspection with Acetic Acid (VIA) and Visual Inspection with Lugol’s Iodine (VILI) are increasingly recommended in various cervical cancer screening protocols in low-resource settings. Although VIA is more widely used, VILI has been advocated as an easier and more specific screening test. VILI has not been well-validated as a stand-alone screening test, compared to VIA or validated for use in HIV-infected women. We carried out a randomized clinical trial to compare the diagnostic accuracy of VIA and VILI among HIV-infected women. Women attending the Family AIDS Care and Education Services (FACES) clinic in western Kenya were enrolled and randomized to undergo either VIA or VILI with colposcopy. Lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Between October 2011 and June 2012, 654 were randomized to undergo VIA or VILI. The test positivity rates were 26.2% for VIA and 30.6% for VILI (p = 0.22). The rate of detection of CIN2+ was 7.7% in the VIA arm and 11.5% in the VILI arm (p = 0.10). There was no significant difference in the diagnostic performance of VIA and VILI for the detection of CIN2+. Sensitivity and specificity were 84.0% and 78.6%, respectively, for VIA and 84.2% and 76.4% for VILI. The positive and negative predictive values were 24.7% and 98.3% for VIA, and 31.7% and 97.4% for VILI. Among women with CD4+ count < 350, VILI had a significantly decreased specificity (66.2%) compared to VIA in the same group (83.9%, p = 0.02) and compared to VILI performed among women with CD4+ count ≥ 350 (79.7%, p = 0.02). VIA and VILI had similar diagnostic accuracy and rates of CIN2+ detection among HIV-infected women.
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Huchko, Megan J, Jennifer Sneden, Jennifer M Zakaras, Karen Smith-McCune, George Sawaya, May Maloba, Elizabeth Ann Bukusi, Craig R Cohen, et al. (2015). A randomized trial comparing the diagnostic accuracy of visual inspection with acetic acid to Visual Inspection with Lugol's Iodine for cervical cancer screening in HIV-infected women. PLoS One, 10(4). p. e0118568. 10.1371/journal.pone.0118568 Retrieved from https://hdl.handle.net/10161/12715.
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Megan Justine Huchko
Megan Huchko, MD, MPH, holds a dual appointment as an Associate Professor in the Department of Obstetrics & Gynecology and the Duke Global Health Institute. Dr. Huchko was an undergraduate at Duke before moving to New York City to complete medical school at the Albert Einstein College of Medicine, and residency training at Columbia Presbyterian Medical Center. She completed her fellowship in Reproductive Infectious Disease the University of California, San Francisco, and was a faculty member there.
Dr. Huchko practices as an ob/gyn generalist and specializes in cervical cancer prevention through her clinical work and global women’s health research. Her research focuses on optimizing the diagnosis and treatment of cervical cancer among vulnerable women in settings where health disparities occur. She has been working with the Family AIDS Care and Education Services (FACES) program in the Nyanza Province of western Kenya since 2006.
She designed and implemented a cervical cancer screening and prevention (CCSP) program for HIV-infected women enrolled in care at FACES. The CCSP program has provided a clinical resource, as well as a cohort to evaluate the epidemiology of cervical cancer among HIV-infected women, the feasibility of integrating cervical cancer prevention programs into HIV and general outpatient clinics, the safety of various diagnostic and treatment modalities, the efficacy of low-cost/low-resource screening modalities in HIV-infected women and provider and patient-level barriers and facilitators to uptake of cervical cancer prevention activities.
Currently, she is carrying out several large studies in central Uganda and western Kenya to evaluate the optimal implementation strategy for HPV-based cervical cancer screening in rural settings. At Duke, she leads the Center of Excellence in Global Women’s Health through the Global Health Institute and serves as Director for the Ob/Gyn Clinical Research Unit (CRU).
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