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A Population-Based Study of Visual Inspection With Acetic Acid (VIA) for Cervical Screening in Rural Nigeria

Ajenifuja, Kayode Olusegun MD, FWACS*; Gage, Julia C. PhD; Adepiti, Akinfolarin C. MD, FMCOG*; Wentzensen, Nicolas PhD; Eklund, Claire MS, SCT(ASCP); Reilly, Mary PhD; Hutchinson, Martha MD; Burk, Robert D. PhD§; Schiffman, Mark MD

International Journal of Gynecological Cancer: March 2013 - Volume 23 - Issue 3 - p 507–512
doi: 10.1097/IGC.0b013e318280f395
Cervical Cancer

Objective Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.

Methods In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.

Results Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.

Conclusion In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.

*Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; †Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD; ‡Women and Infants Hospital, Providence, RI; and §Departments of Microbiology and Immunology, Pediatrics, Obstetrics, Gynecology, and Women’s Health, and Epidemiology and Population Health, Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY.

Address correspondence and reprint requests to Kayode Olusegun Ajenifuja, MD, FWACS, Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University, PMB 5538, Ile-Ife, Osun State, Nigeria. E-mail:

The authors declare no conflicts of interest.

Received September 24, 2012

Accepted December 2, 2012

Copyright © 2013 by IGCS and ESGO