{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:59:02Z","timestamp":1792202342770,"version":"4.4.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1K08CA271949"],"award-info":[{"award-number":["1K08CA271949"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Guidelines for effective triage following positive primary high\u2010risk human papillomavirus (HPV) screening in low\u2010 and middle\u2010income countries with high human immunodeficiency virus (HIV)\u2010prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South\u2010East District, Botswana. Non\u2010pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self\u2010samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire\u00ae HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8\u2010type HPV genotype restriction (16\/18\/31\/33\/35\/45\/52\/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8\u2009years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8\u2010type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92\u201392.85) and women without HIV 85.92% (95% CI: 75.62\u201393.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39\u201370.65], women without HIV 44.29% [95% CI: 32.41\u201356.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15\u201378.41], women without HIV 45.71% [95% CI: 33.74\u201358.06]). However, 8\u2010type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06\u201334.90) and women without HIV 37.06% (95% CI: 32.85\u201341.41). These results were similar when CIN3+ was used as the outcome. When combining 8\u2010type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18\u201384.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18\u201364.84).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Eight\u2010type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade\u2010off between sensitivity and specificity with currently available options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trials registration<\/jats:title><jats:p>This study is registered on <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link> no. NCT04242823, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04242823\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04242823<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15225","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T07:39:40Z","timestamp":1699688380000},"page":"507-518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Triage of HPV positivity in a high HIV prevalence setting: A\u00a0prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana"],"prefix":"10.1002","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1975-8837","authenticated-orcid":false,"given":"Rebecca","family":"Luckett","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Botswana Harvard Health Partnership  Gaborone Botswana"},{"name":"Department of Obstetrics and Gynecology University of Botswana  Gaborone Botswana"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Ramogola\u2010Masire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Botswana  Gaborone Botswana"},{"name":"Department of Obstetrics &amp; Gynecology University of Pretoria  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Gompers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Moraka","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikhulile","family":"Moyo","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership  Gaborone Botswana"},{"name":"Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"School of Health Systems and Public Health University of Pretoria  Pretoria South Africa"},{"name":"Department of Pathology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leatile","family":"Sedabadi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leabaneng","family":"Tawe","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanolo","family":"Kashamba","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelebogile","family":"Gaborone","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anikie","family":"Mathoma","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzad","family":"Noubary","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Northeastern University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maduke","family":"Kula","sequence":"additional","affiliation":[{"name":"National Cervical Cancer Prevention Program Ministry of Health and Wellness Botswana  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Grover","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Dreyer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology University of Pretoria  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthys H.","family":"Botha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Stellenbosch University  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Makhema","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership  Gaborone Botswana"},{"name":"Harvard T.H. 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