Triage of HPV positivity in a high HIV prevalence setting: A prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana

作者：Rebecca Luckett, Doreen Ramogola‐Masire, Annika D. Gompers, Natasha Onalenna Moraka, Sikhulile M. Moyo, Leatile Sedabadi, Leabaneng Tawe, Thanolo Kashamba, Kelebogile Gaborone, Anikie Mathoma, Farzad Noubary, Maduke Kula, Surbhi Grover, Greta Dreyer, Matthys Hendrik Botha, Joseph M. Makhema, Roger Shapiro, Michele R. Hacker · 发表于：International Journal of Gynecology & Obstetrics · 年份：2023 · DOI：10.1002/ijgo.15225 · 被引用次数：13 · 研究领域：Cervical Cancer and HPV Research、Women's cancer prevention and management、Head and Neck Cancer Studies

OBJECTIVE: Guidelines for effective triage following positive primary high-risk human papillomavirus (HPV) screening in low- and middle-income countries with high human immunodeficiency virus (HIV)-prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana. METHODS: We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South-East District, Botswana. Non-pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self-samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8-type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+). RESULTS: Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8...