Volume 5 Supplement 1

Proceedings of the 12-th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI)

Open Access

Challenges in integrating cervical cancer screening in HIV care clinics in West Africa: a pilot study in Abidjan, Côte d’Ivoire

  • Apollinaire Horo1,
  • Antoine Jaquet2Email author,
  • Badian Toure1,
  • Didier K Ekouevi2, 3, 4,
  • Séverin Lenaud4,
  • Benjamin Effi5,
  • Annie J Sasco2,
  • Eugene Messou6,
  • Emmanuel Bissagniene7,
  • Mamourou Kone1 and
  • François Dabis2
Infectious Agents and Cancer20105(Suppl 1):A10

https://doi.org/10.1186/1750-9378-5-S1-A10

Published: 11 October 2010

Background

The ongoing scale-up of antiretroviral therapy (ART) in low-resource settings continues to improve the prognosis of HIV-infected individuals, necessitating a focus on long-term case management especially in women. Facing the particularly high burden of cervical cancer in sub-Saharan Africa, preventive measures are therefore becoming an integral component of a comprehensive approach to the management of patients. We describe here some of the operational aspects of a cervical cancer screening procedure based on visual inspection among HIV-positive women attending ART clinics in Abidjan.

Methods

A cross-sectional study is being conducted in two HIV clinics of Abidjan, since August 2009. A mobile team composed of three trained midwives and a senior gynecologist is in charge of proposing cervical screening based on visual inspection to all HIV-infected women attending participating clinics. Midwives are in charge to perform visual inspection of the cervix with acetic acid (IVA) and lugol’s iodine (IVL). Exclusion criteria are following: no previous cervical cancer or total hysterectomy, aged <25 or >59 years, pregnancy over 20 weeks. They refer positively screened women (IVA+ or IVL+), to a gynecologist in charge of the colposcopy examination (and biopsy if needed). Women with confirmed lesions are proposed an adapted treatment according to local available resources.

Results

Of the first 1,653 HIV-positive women, who attended the cervical screening consultations, 49 were not eligible and 103 were not assessable because of a prevalent cervical infection. The median age of the 1,501 screened women was 37 (IQR 32-43) years, and 1171 (78%) were on ART. 133 (9%) women were positively screened for cervical pre malignancy and referred for medical examination. 69 (4.6%, 95% CI 3.5-5.6) were confirmed by colposocopy and had histological investigation. Results of the 69 biopsy performed were as follows; 48 cervical intraepithelial neoplasia (CIN) of grade 1, 8 CIN grade 2 or 3, 2 invasive carcinoma and 10 nonmalignant findings. 22 patients were treated with cryotherapy, 16 were referred for surgical excision, and 31 were proposed a gynecological followup.

Conclusion

Several barriers were identified as limiting the ability of visual inspection used as a cervical screening method such as a high rate of cervical infection or a high rate of false-positive cervical lesions. Health care systems in West African countries cannot afford the financial and structural burdens of a conventional cervical screening program. Strategies adapted to HIV-infected women and relying on visual inspection appear feasible despite stated limitations and should be further evaluated.

Declarations

Acknowledgements

This abstract is being submitted on behalf of the International Epidemiological Database to Evaluate AIDS in West Africa collaboration.

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.

Authors’ Affiliations

(1)
Service de Gynécologie Obstétrique, CHU de Yopougon
(2)
INSERM CRE U 897, ISPED, Université Victor Segalen
(3)
Clinique MTCT+ Adultes, ACONDA
(4)
Programme PAC-CI, CHU de Treichville
(5)
Service d’Anatomo-Pathologie, CHU de Treichville
(6)
CePReF, ACONDA
(7)
Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville

Copyright

© Horo et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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