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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Triage of HPV positivity in a high HIV prevalence setting: A prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana
International Journal of Gynecology and Obstetrics, Year 2023
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Description
Objective: Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. Methods: We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). Results: Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8-type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92–92.85) and women without HIV 85.92% (95% CI: 75.62–93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39–70.65], women without HIV 44.29% [95% CI: 32.41–56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15–78.41], women without HIV 45.71% [95% CI: 33.74–58.06]). However, 8-type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06–34.90) and women without HIV 37.06% (95% CI: 32.85–41.41). These results were similar when CIN3+ was used as the outcome. When combining 8-type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18–84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18–64.84). Conclusions: Eight-type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade-off between sensitivity and specificity with currently available options. Clinical trials registration: This study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823. © 2023 International Federation of Gynecology and Obstetrics.
Authors & Co-Authors
Luckett, Rebecca
United States, Boston
Beth Israel Deaconess Medical Center
Botswana, Gaborone
Botswana Harvard Health Partnership
Botswana, Gaborone
University of Botswana
United States, Boston
Harvard Medical School
Ramogola-Masire, D.
Botswana, Gaborone
University of Botswana
South Africa, Pretoria
University of Pretoria
Moraka, Natasha Onalenna
Botswana, Gaborone
Botswana Harvard Health Partnership
Moyo, Sikhulile M.
Botswana, Gaborone
Botswana Harvard Health Partnership
United States, Boston
Harvard T.h. Chan School of Public Health
South Africa, Pretoria
University of Pretoria
Botswana, Gaborone
University of Botswana
Tawe, Leabaneng
Botswana, Gaborone
University of Botswana
Kashamba, Thanolo
Botswana, Gaborone
University of Botswana
Mathoma, Anikie M.
Botswana, Gaborone
University of Botswana
Noubary, Farzad
United States, Boston
Northeastern University
Grover, Surbhi
United States, Philadelphia
University of Pennsylvania
Dreyer, Greta
South Africa, Pretoria
University of Pretoria
Botha, Matthys H.
South Africa, Stellenbosch
Stellenbosch University
Makhema, Joseph M.
Botswana, Gaborone
Botswana Harvard Health Partnership
United States, Boston
Harvard T.h. Chan School of Public Health
Shapiro, Roger L.
Botswana, Gaborone
Botswana Harvard Health Partnership
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
Beth Israel Deaconess Medical Center
Hacker, Michele R.
United States, Boston
Beth Israel Deaconess Medical Center
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Authors: 14
Affiliations: 9
Identifiers
Doi:
10.1002/ijgo.15225
ISSN:
00207292
Research Areas
Cancer
Genetics And Genomics
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Botswana
Participants Gender
Female