{"doi":"10.1136/bmjonc-2023-000111","title":"Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia","abstract":"Objective: This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit. Methods and analysis: We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18-65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was cervical intraepithelial neoplasia grade 2 and above (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius) and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% CIs. A sensitivity analysis considered disease when only visible lesions were biopsied. Results: ) and all except one were on antiretroviral therapy. Among 371 participants with histopathological results, 27% (101/371) women had CIN2+ and 23% (23/101) were not detected by any index test. Sensitivity and specificity for stand-alone tests were: hrHPV, 67.3% (95% CI 57.7% to 75.7%) and 65.3% (95% CI 59.4% to 70.7%); Gynocular 51.5% (95% CI 41.9% to 61.0%) and 80.0% (95% CI 74.8% to 84.3%); and VIA 22.8% (95% CI 15.7% to 31.9%) and 92.6% (95% CI 88.8% to 95.2%), respectively. Combining tests did not improve test accuracy measures. All test accuracies improved in sensitivity analysis. Conclusion: The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed. Trial registration number: NCT03931083.","journal":"BMJ Oncology","year":2024,"id":475410,"datarank":0.24440964226637502,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.036465488098391396,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.036465488098391396,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":2,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9499,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03931083"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1169531,"name":"Misinzo Moono","orcid":null,"position":1,"is_corresponding":false},{"id":540811,"name":"Mulindi Mwanahamuntu","orcid":"0000-0001-6378-0276","position":2,"is_corresponding":false},{"id":1069925,"name":"Marie Roumet","orcid":"0000-0001-6655-1428","position":3,"is_corresponding":false},{"id":1069926,"name":"Andreas Limacher","orcid":"0000-0002-9094-9476","position":4,"is_corresponding":false},{"id":1169532,"name":"Herbert Kapesa","orcid":null,"position":5,"is_corresponding":false},{"id":1169533,"name":"Thamsanqa Madliwa","orcid":null,"position":6,"is_corresponding":false},{"id":507048,"name":"Anne WS Rutjes","orcid":"0000-0001-9782-779X","position":7,"is_corresponding":false},{"id":355408,"name":"Partha Basu","orcid":"0000-0003-0124-4050","position":8,"is_corresponding":false},{"id":331896,"name":"Nicola Low","orcid":"0000-0003-4817-8986","position":9,"is_corresponding":false},{"id":1112617,"name":"Albert Manasyan","orcid":"0000-0001-6275-245X","position":10,"is_corresponding":false},{"id":507049,"name":"Julia Bohlius","orcid":"0000-0003-1955-1585","position":11,"is_corresponding":false},{"id":507047,"name":"Katayoun Taghavi","orcid":"0000-0003-0812-0069","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T02:06:16.992586Z","pmid":"39886160","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}