Evaluation of a cervicography-based program to ensure quality of visual inspection of the cervix in HIV-infected women in Johannesburg, South Africa

Cervical cancer is a leading cause of cancer death among women in sub-Saharan Africa [1]. Access to cytology-based screening programs is limited in many African countries owing to the lack of skills, capacity, financial resources, and the inability of women to return for results because of several reasons such as limited transport, work, and childcare issues. Visual inspection with acetic acid (VIA) has been suggested as an alternative method of screening for cervical disease and has similar sensitivity to Pap smears for the detection of high-grade cervical lesions in HIV-infected women [2–4]. Several resource-limited countries are expanding cervical cancer screening using the VIA screening method [5]. A quality assurance (QA) program is crucial to the successful implementation of a cervical cancer screening program. However, data evaluating the effect of QA programs in improving the sensitivity of VIA for the diagnosis of cervical intraepithelial neoplasia 2 or worse (CIN 2+), in HIV-infected women, is limited. We present the results of an evaluation of a QA program for VIA, which was nested within a large screening study comparing human papillomavirus (HPV), cytology, and VIA performed in 1,202 HIV-infected women in South Africa [2]. In addition, we evaluated the level of improved skill among nurses and specialists in correctly interpreting VIA as an indicator for CIN 2+ during the course of the study.