Visual Inspection with Acetic Acid, a Low-Cost Screening Method for Cervical Cancer in Low-Resource Settings, and Low Socioeconomic Strata: Primary Health Care Physicians and General Practitionersâ€”an Appropriate Entry Point for Screening

Nadra Ansari; Fatima Jehangir; Rafia Ansari; Habiba Sharaf Ali; Saira Aslam; Basma Salman

Nadra Ansari Ziauddin University, Family Medicine Dept.
Fatima Jehangir Associate Professor, HOD, Family Medicine Dept. Ziauddin University, Karachi
Rafia Ansari HOD, Consultant Obstetrician and Gynecologist, Chiniot General Hospital Karachi
Habiba Sharaf Ali Professor, Consultant Obstetrician and Gynecologist, Ziauddin University
Saira Aslam Family Medicine, Ziauddin University, Karachi
Basma Salman Family Medicine, Ziauddin University, Karachi

Abstract

Objective: To evaluate the feasibility and effectiveness of visual inspection with acetic acid (VIA) for cervical cancer screening in a primary health care setting for low-resource areas, also aiming to assess the awareness, and risk factors of cervical cancer (CC) among the target population.

Method: This cross-sectional study was conducted at Ziauddin University and Chiniot General Hospital in Karachi, Pakistan, from June 2022 to June 2023, study included 200 married, non-pregnant, and sexually active women aged 21-59 years using convenience sampling. Participants underwent history taking, Cusco's speculum examination, and VIA using 5% acetic acid. Acetowhite changes were observed for one minute, and positive results were confirmed with a pap smear and referred for colposcopy. Diagnostic accuracy parameters, including sensitivity, specificity, positive predictive value, negative predictive value, overall diagnostic accuracy, and logistic regression were assessed using SPSS-20.

Results: The mean age of the participants was 34.79+/- 7.42 years. VIA demonstrated a sensitivity of 50%, specificity of 83.3%, positive predictive value of 2.9%, negative predictive value of 99.4%, and an overall diagnostic accuracy of 83%. The logistic regression model revealed statistical significance (Chi2(19) = 39.07, p = .004, n = 200), indicating that the independent variables collectively influenced VIA results.

Conclusion: Although VIA may not match the robustness of advanced CC screening methods, it remains a promising and feasible technique for low-resource settings due to its simplicity, affordability, and reasonable accuracy. Integrating VIA as a screening tool with primary health care services can strengthen healthcare systems and contribute to reducing the burden of CC.

Keywords: cervical cancer, Visual Inspection with Acetic Acid, primary health care, screening, prevention, human papilloma virus