Effectiveness and Acceptability of Visual Inspection With Acetic Acid as a Screening Test for Cervical Intraepithelial Neoplasia.

introductionCervical carcinoma is a significant burden in developing countries, and it is preventable by early detection of its precursor lesions through screening. AIM AND

objectivesThis study assessed the effectiveness and acceptability of visual inspection of the cervix with acetic acid as a screening test in a low-resource setting, comparing it with colposcopy-guided biopsy as a gold standard test. It also assessed the prevalence of preneoplastic conditions of the cervix and its association with known risk factors for cervical carcinoma. MATERIALS AND METHODOLOGY: A comparative study was conducted among 978 women in the age group of 35-54 years from Velanai MOH area in Jaffna, Sri Lanka, during the period of April 2017 to March 2018. The interviewer administered a questionnaire, Visual Inspection of Cervix with Acetic acid (VIA), and colposcopy reporting forms were used for data collection. All participants were screened with VIA and then subjected to colposcopy immediately. Targeted biopsies were performed in 107 cases. Effectiveness of VIA was assessed by means of sensitivity, specificity, positive predictive value, and negative predictive value. Chi-squared test and Fisher's exact test were used to assess the association of risk factors with cervical intraepithelial neoplasia (CIN) and the acceptability of the screening test.

resultsThe prevalence of preneoplastic conditions, including CIN 1, during the study period of April 2017 to March 2018, was 3.75% in the study population. Early sexual activity, usage of combined oral contraceptive pills, and multiparity were significantly associated with CIN 2 or more lesions (P<0.05). 97.86% of women stated that they would recommend cervical screening with VIA to others. Only six women (0.64%) had heavy bleeding from the biopsy, and 71 women (7.6%) reported severe pain. In detecting CIN 2 or more, the sensitivity of VIA was 70.6%, the specificity was 74.7%, the positive predictive value was 4.9%, and the negative predictive value was 99.3%. When considering the performance of VIA and colposcopy, colposcopy performed well at detecting CIN 2 or more lesions. DISCUSSION: Even though the sensitivity, specificity, and negative predictive value of VIA were high, it has a low positive predictive value. VIA can be used as an alternative screening test in young women in low-resource settings like Sri Lanka. But it should be kept in mind that the higher false positive rate may result in unnecessary interventions and complications, and it is not suitable for older women with a non-visible transformation zone.