Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of precancerous and cancerous cervical lesions in Kampala, Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Infectious Agents and Cancer
Abstract
Although cervical cancer is preventable, most women in sub-Saharan Africa (SSA) do not receive
routine screening and few treatment options exist. Female Sex Workers (FSWs) are among the Ugandan female
population at highest risk of acquiring sexually transmitted infections (STIs) including HIV and human papilloma
viruses (HPV), the cause of cervical cancer. We report one-year experiences of visual inspection with acetic acid (VIA)
positivity among FSWs in the early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda.
Methods: Between June 2014 and July 2015, we enrolled FSWs into a cross-sectional study at a research clinic. The
women were screened using the VIA method (application of 3–5 % acetic acid to the cervix). All VIA positive
women were referred to a tertiary hospital for colposcopy, biopsy, and immediate treatment (if indicated) at the
same visit according to national guidelines. Data on socio-demographic, sexual behaviour, sexual reproductive
health and clinical characteristics were collected. We used logistic regression to identify factors associated with VIA
positivity.
Results: Of 842 women assessed for eligibility, 719 (85 %) of median age 30 (IQR 26, 35) were screened, and 40
(6 %) women were VIA positive. Of the 24 histology specimens analysed, 6 showed inflammation, only 1 showed
cervical intraepithelial neoplasia (CIN) 1, 13 women showed CIN2/3, while 4 women already had invasive cervical
cancer. The overall prevalence of HIV was 43 %, of whom only 35 % were receiving ART. In the age-adjusted
analysis, VIA positivity was more likely among women who reported having > 100 life-time partners (aOR = 3.34,
95 %CI: 1.38–8.12), and HIV positive women (aOR = 4.55; 95 %CI: 2.12–9.84).
Description
Keywords
Female sex workers (FSWs), visual inspection with acetic acid (VIA), cervical intra-epithelial neoplasia (CIN), HIV, Screening
Citation
Namale, G., Mayanja, Y., Kamacooko, O., Bagiire, D., Ssali, A., Seeley, J., ... & Kamali, A. (2021). Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Infectious Agents and Cancer, 16(1), 1-11.https://doi.org/10.1186/s13027-021-00373-4