Prevalance of premalignant cervical lesions: Comparing visual inspection with Pap smear in women attending HIV care clinic at the Webuye District Hospital, Kenya

Jeremiah K. Laktabai
Department of Medicine, Moi University, Kenya
December, 2009
 

Abstract
Background: Cervical cancer is the leading cause of cancer deaths among women in the third world. The HIV positive population is at a higher risk. Reported prevalence of dysplasia varies widely. Pap smear is widely used for screening. VIA is an alternative where resources are limited. There is need to establish the agreement between the two screening tests.

Objectives: To determine the prevalance of cervical abnormalities on VIA and Pap smear among women attending HIV clinic, to determine the correlates of cervical abnormalities and to ascertain the degree of agreement VIA and Pap smear.

Design: Cross-sectional

Setting: Webuye District Hospital Ampath clinic.

Subjects: Women attending HIV clinic at the Webuye District Hospital.

Study methods: A questionnaire was administered to the participants. They then underwent Pap smear test and VIA in one sitting. VIA findings were recorded while Pap specimens were sent for cytologic evaluation.

Results: Sixty two out of the 220 patients (28.2%) had positive VIA findings [95% CI, 22.3-34.6%], while 50 (22.7% ) had positive Pap test [95% CI, 17.4-28.8%]. The degree of agreement between VIA and Pap smear was moderate, with a kappa of 0.56 (95% CI, 0.49-0.63). The higher the grade of abnormality on Pap smear, the bigger the agreement, with 100% agreement for invasive disease, 76.2% for HSIL and 52.0% for LSIL. There were no significant differences among women with positive and negative screening results in socio demographic characteristics, CD4 levels, WHO stage or use of ARVs.

Conclusion and recommendations: There is a high prevalence of cervical abnormalities among HIV population. VIA is a viable screening method for high grade lesions. All HIV positive women should be offered cervical screening irrespective of their socio-demographics or stage of disease.


 

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