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    Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea

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    12
    Author
    Toliman, PJ; Kaldor, JM; Badman, SG; Gabuzzi, J; Silim, S; Kumbia, A; Kombuk, B; Kombati, Z; Munnull, G; Guy, R; ...
    Date
    2018-12-01
    Source Title
    Papillomavirus Research
    Publisher
    ELSEVIER SCIENCE BV
    University of Melbourne Author/s
    Tabrizi, Sepehr; Brotherton, Julia; Wark, Suzanne; Saville, Marion; Nightingale, Claire
    Affiliation
    Melbourne School of Population and Global Health
    Obstetrics and Gynaecology
    Metadata
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    Document Type
    Journal Article
    Citations
    Toliman, P. J., Kaldor, J. M., Badman, S. G., Gabuzzi, J., Silim, S., Kumbia, A., Kombuk, B., Kombati, Z., Munnull, G., Guy, R., Vallely, L. M., Kelly-Hanku, A., Wand, H., Ryan, C., Tan, G., Brotherton, J., Saville, M., Mola, G. D. L., Garland, S. M. ,... Vallely, A. J. (2018). Performance of clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal specimens, and visual inspection of the cervix with acetic acid, for the detection of underlying high-grade squamous intraepithelial lesions in Papua New Guinea. PAPILLOMAVIRUS RESEARCH, 6, pp.70-76. https://doi.org/10.1016/j.pvr.2018.10.009.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253123
    DOI
    10.1016/j.pvr.2018.10.009
    Abstract
    The performance of different clinical screening algorithms comprising point-of-care HPV-DNA testing using self-collected vaginal ('V') specimens, and visual inspection of the cervix with acetic acid (VIA) was evaluated in Papua New Guinea. Women aged 30-59 years provided V specimens that were tested at point-of-care using the Xpert HPV Test (Cepheid, Sunnyvale, CA). A clinician-collected cervical ('C') specimen was then collected for point-of-care Xpert testing, and liquid-based cytology (LBC). Following this, VIA examination was conducted, blind to HPV test results, and ablative cervical cryotherapy provided if indicated. Detection of high-grade squamous intraepithelial lesion (HSIL) by LBC was the reference standard used to evaluate clinical screening algorithms. Of 1005 women, 36 had HSIL+. Xpert HPV Test performance using V specimens (sensitivity 91.7%, specificity 87.0%, PPV 34.0%, NPV 99.3%) was superior to VIA examination alone (51.5%, 81.4%, 17.5%, 95.6% respectively) in predicting underlying HSIL+. A screening algorithm comprising V specimen HPV testing followed by VIA examination had low sensitivity (45.5%) but comparable specificity, PPV and NPV to HPV testing alone (96.3%, 45.5%, 96.3% respectively). A 'test-and-treat' screening algorithm based on point-of-care HPV testing of V specimens had superior performance compared with either VIA examination alone, or a combined screening algorithm comprising HPV testing plus VIA.

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