Prevalence and determinants of high-risk human papillomavirus infection in women from a sub-Saharan African community.

BACKGROUND: Human papillomavirus infection with high-risk types (HR-HPV) is a necessary cause of cervical cancer, the most common malignancy among sub-Saharan African women. Little is known about prevalence of cervical HR-HPV infection in this region. METHODS: A cross-sectional study of 1528 women examined the determinants of HR-HPV infection among women in Kinshasa, Democratic Republic of Congo. Information was collected on sociodemographic, reproductive, lifestyle characteristics, and health-seeking behaviors. Cervical samples were tested for HPV-DNA by Hybrid Capture 2. Unconditional logistic regression identified predictors of HPV positivity. RESULTS: HR-HPV prevalence was 12.5% in all women and 8.7% in women with normal cytology. Prevalence was highest (18.3%) in individuals <35 years of age and gradually decreased with age. Excess HR-HPV infection risk was observed in women who were smokers (odds ratio [OR] = 1.60; 95% confidence interval [CI]: 1.11-2.31), divorced/separated (OR = 1.60; 95% CI: 1.11-2.32), in polygamous marriages (OR = 1.28; 95% CI: 0.90-1.82), using medical contraceptives (OR = 2.40; 95% CI: 1.20-4.80), and who preferred male physicians (OR = 1.90; 95% CI: 1.20-3.05). A statistically marginal increase was found in women whose partners had sex with prostitutes (OR = 2.40; 95% CI: 0.72-8.01). A higher standard of living was associated with reduced risk. CONCLUSION: HR-HPV positivity was associated with behavioral and sexual characteristics thought to affect risk of new infections and immune function. However, HPV prevalence did not correlate with numbers of sex partners, possibly because of a high HPV infection rate per sexual contact or because subjects were older than 30 years. Our study should assist in designing strategies for control of cervical cancer in this low-resource, high cervical cancer risk setting in sub-Saharan Africa.

Visual inspection as a cervical cancer screening method in a primary health care setting in Africa.

We evaluated the feasibility and performance of visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening in a primary health-care setting in Kinshasa, Congo. Women (1,528) aged > or =30 years were screened independently by nurses and physicians by VIA and VILI and Pap cytology. Biopsy samples were obtained from women with abnormal colposcopies and from 290 randomly chosen women with normal colposcopy. Cytological and histological examinations were performed in Lyon and Montreal, respectively. The prevalence of cervical intraepithelial neoplasia (CIN) of grades 1, 2 and 3 was 4.5, 1.3 and 4%, respectively. Using biopsy as the reference, the sensitivity, specificity and negative predictive value (NPV) for > or =CIN 2 for VIA-nurse were 55.5% (95% CI: 34.7-76.2), 64.6% (95% CI: 62.0-67.1) and 96.8% (95% CI: 93.5-98.7), respectively. The corresponding values for VILI-nurse were 44.0% (95% CI: 24.2-63.8), 74.6% (95% CI: 72.3-76.9) and 96.7% (95% CI: 93.7-98.6). The equivalent parameters for physicians were 71.1% (95% CI: 46.7-95.5), 71.3% (95% CI: 68.9-73.6) and 98.6% (95% CI: 96.0-99.7) for VIA and 68.3% (95% CI: 42.5-94.0), 76.2% (95% CI: 74.0-78.4) and 97.2% (95% CI: 95.3-98.5) for VILI. The sensitivity of cytology ranged between 31 and 72%, depending on the abnormality threshold used to define positivity, with a corresponding specificity range of 94-99% and a NPV range of 97-99%. Our results show that VIA and VILI performed by nurses and physicians are slightly more sensitive but less specific than Pap cytology across multiple combinations of test and lesion thresholds. Given their lower cost and easy deployment, visual inspection methods merit further assessment as cervical cancer screening methods for low-resource countries.