{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:35:50Z","timestamp":1787888150207,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,2,28]],"date-time":"2014-02-28T00:00:00Z","timestamp":1393545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the determinants of a positive visual inspection after acetic acid (<jats:styled-content style=\"fixed-case\">VIA<\/jats:styled-content>), including the relationship of testing positive for high\u2010risk human papillomavirus (<jats:styled-content style=\"fixed-case\">HR\u2010HPV<\/jats:styled-content>), which is the necessary cause of cervical cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three clinical sites in rural China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 7541 women aged 25\u201365\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All women underwent VIA, DNA testing, by two DNA tests performed on both clinician\u2010 and self\u2010collected specimens, and HPV E6 oncoprotein testing. Those positive by any test underwent colposcopy and four\u2010quadrant biopsy evaluation. A random sample of women with negative screening results also underwent colposcopy and, if colposcopic abnormalities were observed, four\u2010quadrant biopsy evaluation was performed. Women diagnosed with cervical intraepithelial neoplasia grade\u00a02 (CIN2), or more severe grades (CIN2\u00a0+\u00a0), underwent treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measure<\/jats:title><jats:p>Testing positive for VIA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 7.6% (95% confidence interval, 95%\u00a0CI, 7.0\u20138.2%) had a positive VIA. Women who tested positive for HPV were more likely to have a positive VIA than women who tested negative for HPV (15.0%, 95%\u00a0CI 12.9\u201317.2% versus 6.3%, 95%\u00a0CI 5.7\u20136.9%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Older women were less likely to have a positive VIA (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001), including women with CIN2\u00a0+\u00a0 (<jats:italic>P<\/jats:italic><jats:sub>trend<\/jats:sub>\u00a0&lt;\u00a00.001). A logistic regression model demonstrated that diagnosis (CIN2\u00a0+\u00a0 versus &lt;CIN2; odds ratio, OR, 32; 95%\u00a0CI 11\u2013100), testing HPV positive with a higher viral load (highest versus lowest; OR\u00a04.3; 95%\u00a0CI 2.5\u20137.4), and age (51\u00a0years and older versus &lt;38\u00a0years; OR\u00a00.22; 95%\u00a0CI 0.17\u20130.30) were independent determinants of having a positive VIA. VIA was more likely to be positive for women with CIN2\u00a0+\u00a0having an abnormal colposcopic impression versus women with CIN2\u00a0+\u00a0 regardless of colposcopic impression (71.4 versus 47.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The age of the population and method of disease ascertainment should be considered in the interpretation of any VIA performance.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12646","type":"journal-article","created":{"date-parts":[[2014,2,28]],"date-time":"2014-02-28T07:34:44Z","timestamp":1393572884000},"page":"739-746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical determinants of a positive visual inspection after treatment with acetic acid for cervical cancer screening"],"prefix":"10.1111","volume":"121","author":[{"given":"PE","family":"Castle","sequence":"first","affiliation":[{"name":"Global Cancer Initiative Chestertown MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y\u2010L","family":"Qiao","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u2010H","family":"Zhao","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Chen","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Valdez","sequence":"additional","affiliation":[{"name":"PATH Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"X","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u2010N","family":"Kang","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Bansil","sequence":"additional","affiliation":[{"name":"PATH Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Paul","sequence":"additional","affiliation":[{"name":"PATH Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Bai","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Peck","sequence":"additional","affiliation":[{"name":"PATH Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Li","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Chen","sequence":"additional","affiliation":[{"name":"Cancer Institute and Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Jeronimo","sequence":"additional","affiliation":[{"name":"PATH Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,28]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"FerlayJ ShinHR BrayF FormanD MathersC ParkinDM.GLOBOCAN 2008 v2.0 Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet].Lyon France:International Agency for Research on Cancer;2010."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.05.113"},{"key":"e_1_2_6_4_1","unstructured":"Cervix Cancer Screening.10. 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