{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:23:54Z","timestamp":1780446234152,"version":"3.54.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ESTHER Switzerland","award":["17G1"],"award-info":[{"award-number":["17G1"]}]},{"name":"Service de Solidarit\u00e9 Internationale"},{"DOI":"10.13039\/501100006388","name":"H\u00f4pitaux Universitaires de Gen\u00e8ve","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006388","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fondation priv\u00e9 of HUG"},{"name":"Commission des Affaires Humanitaires of HUG"},{"name":"Groupement Romand de la Soci\u00e9t\u00e9 Suisse de Gyn\u00e9cologie et Obst\u00e9trique"},{"name":"University of Dschang"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>World Health Organization guidelines for cervical cancer screening recommend HPV testing followed by visual inspection with acetic acid (VIA) for triage if HPV positive. In order to improve visual assessment and identification of cervical intraepithelial neoplasia grade 2 and worse (CIN2+), providers may use visual aids such as digital cameras.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To determine whether combined examination by naked-eye and digital VIA (D-VIA) and VILI (D-VILI) improves detection of CIN2+ as compared to the conventional evaluation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Women (30\u201349 years) living in Dschang (West Cameroon) were prospectively invited to a cervical cancer screening campaign. Primary HPV-based screening was followed by VIA\/VILI and D-VIA\/VILI if HPV-positive. Health care providers independently defined diagnosis (pathological or non-pathological) based on naked-eye VIA\/VILI and D-VIA\/VILI. Decision to treat was based on combined examination (VIA\/VILI and D-VIA\/VILI). Cervical biopsy and endocervical curettage were performed in all HPV-positive participants and considered as reference standard. Diagnostic performance of individual and combined naked-eye VIA\/VILI and D-VIA\/VILI was evaluated. A sample size of 1,500 women was calculated assuming a prevalence of 20% HPV positivity and 10% CIN2+ in HPV-positive women.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Due to the COVID-19 pandemic, the study had to terminate prematurely. A total of 1,081 women with a median age of 40 (IQR 35.5\u201345) were recruited. HPV positivity was 17.4% (n = 188) and 26 (14.4%) had CIN2+. Naked-eye VIA and D-VIA sensitivities were 80.8% (95% CI 60.6\u201393.4) and 92.0% (95% CI 74.0\u201399.0), and specificities were 31.2% (95% CI 24\u201339.1) and 31.6% (95% CI 24.4\u201339.6), respectively. The combination of both methods yielded a sensitivity of 92.3% (95% CI 74.9\u201399.1) and specificity of 23.2% (95% CI 16.8\u201330.7). A trend towards improved sensitivity was observed, but did not reach statistical significance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Addition of D-VIA\/VILI to conventional naked-eye examination may be associated with improved CIN2+ identification. Further studies including a larger sample size are needed to confirm these results.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0268015","type":"journal-article","created":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T17:45:56Z","timestamp":1652377556000},"page":"e0268015","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Addition of digital VIA\/VILI to conventional naked-eye examination for triage of HPV-positive women: A study conducted in a low-resource setting"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8260-8308","authenticated-orcid":true,"given":"Eva","family":"Dufeil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5157-1378","authenticated-orcid":true,"given":"Bruno","family":"Kenfack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Tincho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0055-0902","authenticated-orcid":true,"given":"Jovanny","family":"Fouogue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ania","family":"Wisniak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7111-3975","authenticated-orcid":true,"given":"Jessica","family":"Sormani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Vassilakos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Petignat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,12]]},"reference":[{"key":"pone.0268015.ref001","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3322\/caac.21262","article-title":"Global cancer statistics, 2012","volume":"65","author":"LA Torre","year":"2015","journal-title":"CA CANCER J CLIN"},{"key":"pone.0268015.ref002","doi-asserted-by":"crossref","first-page":"3262","DOI":"10.1016\/j.ejca.2013.04.024","article-title":"Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors","volume":"49","author":"S Vaccarella","year":"2013","journal-title":"European Journal of Cancer"},{"key":"pone.0268015.ref003","first-page":"7","article-title":"Worldwide burden of cancer attributable to HPV by site, country and HPV type","author":"C de Martel","year":"2017","journal-title":"Cancer Epidemiology"},{"key":"pone.0268015.ref004","unstructured":"Globocan. 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