Although cervical cancer is preventable, most women in sub-Saharan Africa (SSA) do not receive routine screening and few treatment options exist. Female Sex Workers (FSWs) are among the Ugandan female population at highest risk of acquiring sexually transmitted infections (STIs) including HIV and human papilloma viruses (HPV), the cause of cervical cancer. We report one-year experiences of visual inspection with acetic acid (VIA) positivity among FSWs in the early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Between June 2014 and July 2015, we enrolled FSWs into a cross-sectional study at a research clinic. The women were screened using the VIA method (application of 3–5 % acetic acid to the cervix). All VIA positive women were referred to a tertiary hospital for colposcopy, biopsy, and immediate treatment (if indicated) at the same visit according to national guidelines. Data on socio-demographic, sexual behaviour, sexual reproductive health and clinical characteristics were collected. We used logistic regression to identify factors associated with VIA positivity. Of 842 women assessed for eligibility, 719 (85 %) of median age 30 (IQR 26, 35) were screened, and 40 (6 %) women were VIA positive. Of the 24 histology specimens analysed, 6 showed inflammation, only 1 showed cervical intraepithelial neoplasia (CIN) 1, 13 women showed CIN2/3, while 4 women already had invasive cervical cancer. The overall prevalence of HIV was 43 %, of whom only 35 % were receiving ART. In the age-adjusted analysis, VIA positivity was more likely among women who reported having > 100 life-time partners (aOR = 3.34, 95 %CI: 1.38–8.12), and HIV positive women (aOR = 4.55; 95 %CI: 2.12–9.84). We found a relatively low proportion of VIA positivity in this population. The experience from our program implies that the VIA results are poorly reproducible even among a category of trained professional health workers. VIA positivity was more likely among women with a high number of sexual partners and HIV infection. Interventions for improving cervical cancer screening should be recommended as part of HIV care for FSWs to reduce the disease burden in this population.

中文翻译：

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女性性工作者中乙酸（VIA）阳性的外观检查：一项横断面研究，着重指出了在乌干达坎帕拉早期发现癌前和癌前宫颈病变的一年经验

尽管子宫颈癌是可以预防的，但撒哈拉以南非洲地区（SSA）的大多数妇女都没有接受常规筛查，并且几乎没有治疗选择。乌干达女性人口中的女性性工作者（FSW）是罹患包括宫颈癌的艾滋病毒和人类乳头瘤病毒（HPV）在内的性传播感染（STI）的最高风险。我们报告了在乌干达坎帕拉的癌前和癌前宫颈病变的早期检测中，FSW之间用乙酸（VIA）阳性进行目视检查的一年经验。在2014年6月至2015年7月之间，我们将FSW纳入了一家研究诊所的横断面研究。使用VIA方法（在宫颈中使用3-5％的乙酸）对妇女进行筛查。所有VIA阳性女性均被转诊至三级医院进行阴道镜检查，活检，并根据国家指南在同一次就诊时立即治疗（如果有指示）。收集了有关社会人口统计学，性行为，性生殖健康和临床特征的数据。我们使用逻辑回归来确定与VIA阳性相关的因素。在842位合格女性中，有719位（85％）的中位年龄30岁（IQR 26，35）进行了筛查，而40位女性（6％）的VIA阳性。在分析的24份组织学标本中，有6份显示炎症，只有1份显示宫颈上皮内瘤变（CIN）1，有13例显示CIN2 / 3，而4例已经患有浸润性宫颈癌。HIV的总体患病率为43％，其中只有35％的患者接受抗逆转录病毒治疗。在经过年龄调整的分析中，报告有超过100个终生伴侣的女性中，VIA阳性的可能性更高（aOR = 3.34，95％CI：1.38–8.12），和HIV阳性妇女（aOR = 4.55； 95％CI：2.12-9.84）。我们发现该人群中VIA阳性的比例相对较低。我们计划的经验表明，即使在经过培训的专业卫生工作者中，VIA结果的重现性也很差。有大量性伴侣和艾滋病毒感染的女性中，VIA阳性的可能性更高。应该建议采取干预措施来改善子宫颈癌筛查，作为对FSW进行HIV护理的一部分，以减少该人群的疾病负担。有大量性伴侣和艾滋病毒感染的女性中，VIA阳性的可能性更高。应该建议采取干预措施来改善子宫颈癌的筛查，作为对FSW进行HIV护理的一部分，以减少该人群的疾病负担。有大量性伴侣和艾滋病毒感染的女性中，VIA阳性的可能性更高。应该建议采取干预措施来改善子宫颈癌筛查，作为对FSW进行HIV护理的一部分，以减少该人群的疾病负担。