Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa
Journal of Lower Genital Tract Disease
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa; Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States; Centre for HIV and STIs, National Institute of Communicable Diseases, National Health Laboratory Service, United States; University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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. © 2014, American Society for Colposcopy and Cervical Pathology.
acetic acid; acetic acid; adult; aged; Article; camera; cancer grading; cervicography; clinical evaluation; colposcopy; female; gynecological examination; human; Human immunodeficiency virus infection; image quality; major clinical study; nonhuman; Papanicolaou test; paramedical education; photography; predictive value; quality control; sensitivity and specificity; South Africa; uterine cervix biopsy; uterine cervix carcinoma; uterine cervix carcinoma in situ; uterine cervix cytology; Cervical Intraepithelial Neoplasia; complication; evaluation study; fluorescence imaging; health care quality; Human immunodeficiency virus infection; procedures; Uterine Cervical Neoplasms; Acetic Acid; Cervical Intraepithelial Neoplasia; Colposcopy; Female; HIV Infections; Humans; Optical Imaging; Quality Assurance, Health Care; Sensitivity and Specificity; South Africa; Uterine Cervical Neoplasms