Direct Visual Inspection with Acetic Acid: A Cost-Effective Test for Cervical Cancer Screening

Background: Cervical cancer is a major public health problem in developing countries due to ineffective screening programs. This study aimed to determine the accuracy of visual inspection with acetic acid (VIA) for cervical cancer screening in low-income population.  Methods: This cross-sectional study was conducted in an outdoor clinic of Dow University Hospital from July 2016 to July 2017. A total of 108 women with vaginal discharge, post coital bleeding, inter menstrual bleeding and dyspareunia were enrolled in the study. A solution of 5% acetic acid was applied to the cervix and examined under adequate light for 1 min. VIA was reported as positive or negative according to acetowhite changes. Positive results were confirmed by biopsy. SPSS was used for statistical analysis. Sensitivity and specificity were calculated. Chi Squared test was applied and p-value ≤0.05 was considered statistically significant. Results: The average age of the patients was (mean± SD) 45.67±9.67 years. Out of forty-two patients who were VIA positive, n=38 had biopsy confirmed malignancy compared to seventeen women from the screened negative population (n=66) showing a sensitivity of 69.1% and specificity of 92.5%. We found 100% sensitivity and specificity in primipara. The positive predictive value (90.5%), negative predictive value (74.5%) and diagnostic accuracy of VIA positive were 80.6% respectively. Conclusion: VIA is a simple, cost effective and reliable screening test in low socioeconomic areas allowing instant diagnosis and treatment (p=0.0005). Thus, it decreases the chance of loss to follow-up and the number of visits to a healthcare provider. Keywords: Cervical Cancer; Visual Inspection with Acetic Acid; Screening.