Visual inspection with acetic acid test qualities in a secondary setting

To evaluate the visual inspection using acetic acid (VIA) test qualities in a secondary (follow-up) setting, 1 year after cryotherapy treatment performed as part of the Safety, Acceptability and Feasibility demonstration project designed to evaluate the safety, acceptability and feasibility of VIA. An immediate offer of cryotherapy was made to those who test positive and are eligible for treatment.

At 1 year after cryotherapy, 648 women received both a secondary (follow-up) VIA test by nurse-providers, and colposcopy with biopsy, if indicated, by trained physician colposcopists at a referral hospital. All pathologic specimens were sent for examination by a single pathologist.

VIA nurse-providers assessed 42 of the 648 women (6.5%) referred as abnormal (i.e. they tested positive or were suspected of having cancer). Among the 42, the final colposcopic-based diagnosis was HSIL or higher in three cases (7.1%), of which two were HSIL and one was adenocarcinoma. Of the 606 VIA negative women, the colposcopic-based diagnosis was HSIL in only two cases (0.3%).

The VIA test qualities in this setting were: a positive rate of 6.5%, a sensitivity of 60%, a specificity of 93.9%, a positive predictive value of 7.1%, a negative predictive value of 99.7% and an accuracy of 93.7%. These results are comparable to those of Pap smear in most settings.