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Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-Infected Women in Lusaka, Zambia

Bateman, Allen C. PhD, MPH*,†; Parham, Groesbeck P. MD*,†,‡; Sahasrabuddhe, Vikrant V. MBBS, DrPH§; Mwanahamuntu, Mulindi H. MBBS, MMed*,‡; Kapambwe, Sharon MBChB, MPH*; Katundu, Katundu MSc*; Nkole, Theresa MD, MMed; Mulundika, Jacqueline MBChB, MMed, MPH; Pfaendler, Krista S. MD; Hicks, Michael L. MD; Shibemba, Aaron MD, MMed; Vermund, Sten H. MD, PhD§; Stringer, Jeffrey S.A. MD*,†; Chibwesha, Carla J. MD, MSc*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2014 - Volume 67 - Issue 2 - p 212–215
doi: 10.1097/QAI.0000000000000270
Brief Report: Epidemiology and Prevention

Abstract: Although there is a growing literature on the clinical performance of visual inspection with acetic acid in HIV-infected women, to the best of our knowledge, none have studied visual inspection with acetic acid enhanced by digital cervicography. We estimated clinical performance of cervicography and cytology to detect cervical intraepithelial neoplasia grade 2 or worse. Sensitivity and specificity of cervicography were 84% [95% confidence interval (CI): 72 to 91) and 58% (95% CI: 52 to 64). At the high-grade squamous intraepithelial lesion or worse cutoff for cytology, sensitivity and specificity were 61% (95% CI: 48 to 72) and 58% (95% CI: 52 to 64). In our study, cervicography seems to be as good as cytology in HIV-infected women.

*Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;

University of North Carolina at Chapel Hill, Chapel Hill, NC;

University Teaching Hospital, Lusaka, Zambia;

§Vanderbilt University, Nashville, TN;

University of Cincinnati, Cincinnati, OH; and

Michigan Cancer Institute, Pontiac, MI.

Correspondence to: Carla J. Chibwesha, MD, MSc, Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia (e-mail:

Supported by U.S. National Cancer Institute Award 3P30AI027767-19. Investigator support was provided through Fogarty International Center Awards (R25TW009340 to the UNC Hopkins Morehouse Tulane Fogarty Global Health Fellows Program and R24TW007988 to the Fogarty International Clinical Research Scholars Support Center at Vanderbilt-AAMC) and National Cancer Institute Award 1D43CA153784.

S.H.V. is a consultant with the World Health Organization and World Bank, and has received payment from Mead–Johnson for serving as a faculty mentor. The other authors have no conflicts of interest to disclose.

Received January 20, 2014

Accepted May 23, 2014

© 2014 by Lippincott Williams & Wilkins