Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women

Birgitte Baldur-Felskov, Julius Mwaiselage, Mette Tuxen Faber, Myassa Kjaerem, Cecilie Dovey de la Cour, Christian Munk, Crispin Kahesa, Thomas Iftner, Vibeke Rasch, Susanne K Kjaer

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Resumé

OBJECTIVES: Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high-grade lesions on cytology.

METHODS: We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs).

RESULTS: The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34-5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37-2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95% CI: 50.4-240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78-2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity.

CONCLUSIONS: Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.

OriginalsprogEngelsk
TidsskriftTropical Medicine & International Health
Vol/bind24
Udgave nummer2
Sider (fra-til)229-237
ISSN1360-2276
DOI
StatusUdgivet - feb. 2019

Fingeraftryk

Cell Biology
Odds Ratio
HIV
Confidence Intervals
Body Mass Index
Risk Adjustment
Early Detection of Cancer
Uterine Cervical Neoplasms
Developing Countries
Cross-Sectional Studies
Logistic Models

Bibliografisk note

© 2018 John Wiley & Sons Ltd.

Citer dette

Baldur-Felskov, Birgitte ; Mwaiselage, Julius ; Faber, Mette Tuxen ; Kjaerem, Myassa ; de la Cour, Cecilie Dovey ; Munk, Christian ; Kahesa, Crispin ; Iftner, Thomas ; Rasch, Vibeke ; Kjaer, Susanne K. / Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women. I: Tropical Medicine & International Health. 2019 ; Bind 24, Nr. 2. s. 229-237.
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title = "Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women",
abstract = "OBJECTIVES: Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high-grade lesions on cytology.METHODS: We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs).RESULTS: The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95{\%} CI: 2.34-5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95{\%} CI: 1.37-2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95{\%} CI: 50.4-240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95{\%} CI: 0.78-2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity.CONCLUSIONS: Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.",
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author = "Birgitte Baldur-Felskov and Julius Mwaiselage and Faber, {Mette Tuxen} and Myassa Kjaerem and {de la Cour}, {Cecilie Dovey} and Christian Munk and Crispin Kahesa and Thomas Iftner and Vibeke Rasch and Kjaer, {Susanne K}",
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Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women. / Baldur-Felskov, Birgitte; Mwaiselage, Julius; Faber, Mette Tuxen; Kjaerem, Myassa; de la Cour, Cecilie Dovey; Munk, Christian; Kahesa, Crispin; Iftner, Thomas; Rasch, Vibeke; Kjaer, Susanne K.

I: Tropical Medicine & International Health, Bind 24, Nr. 2, 02.2019, s. 229-237.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Factors associated with a cervical high-grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women

AU - Baldur-Felskov, Birgitte

AU - Mwaiselage, Julius

AU - Faber, Mette Tuxen

AU - Kjaerem, Myassa

AU - de la Cour, Cecilie Dovey

AU - Munk, Christian

AU - Kahesa, Crispin

AU - Iftner, Thomas

AU - Rasch, Vibeke

AU - Kjaer, Susanne K

N1 - © 2018 John Wiley & Sons Ltd.

PY - 2019/2

Y1 - 2019/2

N2 - OBJECTIVES: Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high-grade lesions on cytology.METHODS: We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs).RESULTS: The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34-5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37-2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95% CI: 50.4-240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78-2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity.CONCLUSIONS: Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.

AB - OBJECTIVES: Cervical cancer screening by visual inspection with acetic acid (VIA) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high-grade lesions on cytology.METHODS: We conducted a large cross-sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio-demographic, reproductive and lifestyle factors. Blood samples were tested for HIV, and a gynaecological examination was performed. Human papillomavirus (HPV) status was determined by Hybrid Capture 2, and HPV genotyping was done using the LiPA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios (ORs) and confidence intervals (CIs).RESULTS: The strongest risk factors for VIA positivity were positivity to HIV (OR = 3.48; 95% CI: 2.34-5.17) or to high-risk HPV (HrHPV) (OR = 1.97; 95% CI: 1.37-2.85). HrHPV was by far the strongest predictor of high-grade cytology (OR = 110.1; 95% CI: 50.4-240.4), while there was no significant association with HIV in the multivariable analysis (OR = 1.27; 95% CI: 0.78-2.08). After adjustment for HrHPV, HIV and age, the risk of high-grade cytology also increased with increasing age, number of births and low body mass index (BMI), while high BMI decreased the risk of VIA positivity.CONCLUSIONS: Infection with HrHPV is a major risk factor for high-grade cytology, while VIA positivity is associated with HIV and to a lesser extent with HrHPV.

KW - Tanzania

KW - high-grade squamous intraepithelial lesions

KW - human immunodeficiency virus

KW - human papillomavirus

KW - visual inspection with acetic acid

U2 - 10.1111/tmi.13184

DO - 10.1111/tmi.13184

M3 - Journal article

C2 - 30444556

VL - 24

SP - 229

EP - 237

JO - Tropical Medicine & International Health

JF - Tropical Medicine & International Health

SN - 1360-2276

IS - 2

ER -