{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:38:36Z","timestamp":1777927116818,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2015,6,30]],"date-time":"2015-06-30T00:00:00Z","timestamp":1435622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:p>Cervical cancer is the most common cancer among women in Malawi. National guidelines recommend screening women aged 30\u201345 years every five years; however, no specific recommendations exist for women with HIV. We aimed to assess the frequency of high-grade dysplasia (CIN 2 or CIN3) and cervical cancer among women in central Malawi and to examine associations with CIN2+ (CIN2\/3 or cancer). We extracted cervical Pap smear, biopsy, loop electrosurgical excision procedure and uterine specimen reports from a hospital pathology database from November 2012 to November 2013. We used logistic regression to estimate associations with CIN2+. We reviewed specimens from 824 women; we excluded 194 with unknown HIV status, leaving 630 in the analytic sample. Twelve percent had high-grade dysplasia and 109 women (17%) had cancer. Twenty-five percent of high-grade dysplasia cases and 35% of cancers occurred among women outside recommended screening ages. The odds of having CIN2+ were 6.55 times (95% CI 4.44-9.67) greater for HIV+ women. High-grade dysplasia and cervical cancer are very common among Malawian women, especially HIV+ women. HIV infection was strongly associated with CIN2+. Expanding screening to women not covered by current guidelines could avert a substantial proportion of cervical cancer cases in Malawi.<\/jats:p>","DOI":"10.1177\/0956462415592999","type":"journal-article","created":{"date-parts":[[2015,6,30]],"date-time":"2015-06-30T21:55:58Z","timestamp":1435701358000},"page":"753-760","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi"],"prefix":"10.1177","volume":"27","author":[{"given":"Racquel E","family":"Kohler","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Tang","sequence":"additional","affiliation":[{"name":"Division of Global Women\u2019s Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satish","family":"Gopal","sequence":"additional","affiliation":[{"name":"Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"},{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lameck","family":"Chinula","sequence":"additional","affiliation":[{"name":"UNC Project Malawi, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina C","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N George","family":"Liomba","sequence":"additional","affiliation":[{"name":"UNC Project Malawi, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Chiudzu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,6,30]]},"reference":[{"key":"bibr1-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27410"},{"key":"bibr2-0956462415592999","unstructured":"Ferlay J, Shin H, Bray F, et\u00a0al. GLOBOCAN 2008 v2.0, cancer incidence and mortality worldwide. Lyon, France: International Agency for Research on Cancer."},{"key":"bibr3-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-5-149"},{"key":"bibr4-0956462415592999","doi-asserted-by":"publisher","DOI":"10.4236\/health.2012.411155"},{"key":"bibr5-0956462415592999","volume-title":"Cervical cancer screening in developing countries","author":"WHO","year":"2002"},{"key":"bibr6-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61351-2"},{"key":"bibr7-0956462415592999","unstructured":"GLOBOCAN 2012 v1.0., cancer incidence and mortality worldwide: IARC cancer base no. 11, http:\/\/globocan.iarc.fr (2013, accessed 6 June 2015)."},{"key":"bibr8-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61416-0"},{"key":"bibr9-0956462415592999","unstructured":"Ministry of Health:\n                      Malawi National reproductive Health Service Delivery Guidelines\n                      . Lilongwe, Malawi: Ministry of Health, 2009. Chapter 13, pp.135\u2013150."},{"key":"bibr10-0956462415592999","unstructured":"Malawi Ministry of Health. VIA programme report, June 2011."},{"key":"bibr11-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.06.045"},{"key":"bibr12-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181743327"},{"key":"bibr13-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1159\/000325079"},{"key":"bibr14-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000253361.63578.14"},{"key":"bibr15-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.07.092"},{"key":"bibr16-0956462415592999","doi-asserted-by":"crossref","unstructured":"Denslow SA, Rositch AF, Firnhaber C, et\u00a0al. Incidence and progression of cervical lesions in women with HIV: a systematic global review.\n                      Int J STD AIDS\n                      2014; 25: 163\u2013177.","DOI":"10.1177\/0956462413491735"},{"key":"bibr17-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0b013e3182094d78"},{"key":"bibr18-0956462415592999","unstructured":"UNAIDS.\n                      Malawi country overview\n                      . Available at http:\/\/www.unaids.org\/en\/regionscountries\/countries\/malawi\/ (2013, accessed March 2014)."},{"key":"bibr19-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70109-8"},{"key":"bibr20-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070361"},{"key":"bibr21-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1438.2001.01022.x"},{"key":"bibr22-0956462415592999","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-153-7-201010050-00008"},{"key":"bibr23-0956462415592999","volume-title":"Malawi demographics and health survey 2010","author":"National Statistical Office and ICF Macro","year":"2011"},{"key":"bibr24-0956462415592999","volume-title":"WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention","author":"WHO","year":"2013"},{"key":"bibr25-0956462415592999","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70598-3"}],"container-title":["International Journal of STD &amp; AIDS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0956462415592999","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0956462415592999","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0956462415592999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:35:18Z","timestamp":1777674918000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0956462415592999"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,30]]},"references-count":25,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2016,8]]}},"alternative-id":["10.1177\/0956462415592999"],"URL":"https:\/\/doi.org\/10.1177\/0956462415592999","relation":{},"ISSN":["0956-4624","1758-1052"],"issn-type":[{"value":"0956-4624","type":"print"},{"value":"1758-1052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,30]]}}}