{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:44:23Z","timestamp":1783637063954,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T00:00:00Z","timestamp":1637798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Single-visit \u201cscreen-and-treat\u201d strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3\u20138 September 2017, trained nurses examined 222 women aged 23\u201358 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 \u201c\u2026using HPV DNA detection as the primary screening test rather than VIA or cytology\u201d.<\/jats:p>","DOI":"10.3390\/ijerph182312406","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T05:23:02Z","timestamp":1638163382000},"page":"12406","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA"],"prefix":"10.3390","volume":"18","author":[{"given":"Anne","family":"Jeffries","sequence":"first","affiliation":[{"name":"Robert Stempel (RS) College of Public Health and Social Work, Florida International University (FIU), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo M.","family":"Beck-Sagu\u00e9","sequence":"additional","affiliation":[{"name":"Robert Stempel (RS) College of Public Health and Social Work, Florida International University (FIU), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel Bernardo","family":"Marroquin-Garcia","sequence":"additional","affiliation":[{"name":"Partner for Surgery, McLean, VA 22101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2234-0631","authenticated-orcid":false,"given":"Michael","family":"Dean","sequence":"additional","affiliation":[{"name":"Laboratory of Translational Genomics, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"McCoy","sequence":"additional","affiliation":[{"name":"Robert Stempel (RS) College of Public Health and Social Work, Florida International University (FIU), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Aurelio","family":"Cordova-Toma","sequence":"additional","affiliation":[{"name":"Partner for Surgery, McLean, VA 22101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Fenkl","sequence":"additional","affiliation":[{"name":"Robert Stempel (RS) College of Public Health and Social Work, Florida International University (FIU), Miami, FL 33199, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-3394","authenticated-orcid":false,"given":"Purnima","family":"Madhivanan","sequence":"additional","affiliation":[{"name":"Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/carcin\/bgp263","article-title":"The global burden of cancer: Priorities for prevention","volume":"1","author":"Thun","year":"2010","journal-title":"Carcinogenesis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/j.jcv.2004.12.008","article-title":"The epidemiology of human papillomavirus infections","volume":"32S","author":"Baseman","year":"2005","journal-title":"J. Clin. Virol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5306","DOI":"10.1590\/S0036-36342003000900004","article-title":"Incidence and mortality of cervical cancer in Latin America","volume":"45","author":"Arrossi","year":"2003","journal-title":"Salud Publica Mex"},{"key":"ref_4","first-page":"577","article-title":"Epidemiology of cervical cancer in Latin America","volume":"9","year":"2015","journal-title":"Ecancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1002\/ijc.32956","article-title":"Cervical cancer burden in Latin America and the Caribbean: Where are we?","volume":"147","author":"Pilleron","year":"2020","journal-title":"Int. J. Cancer."},{"key":"ref_6","unstructured":"World Health Organization Guidelines (2021, November 08). WHO Guidelines for Screening and Treatment of Precancerous Lesions for Cervical Cancer Prevention. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/94830\/9789241548694_eng.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/QAI.0000000000001539","article-title":"Cryotherapy reduces progression of cervical intraepithelial neoplasia Grade 1 in South African HIV-infected Women: A randomized, controlled trial","volume":"76","author":"Firnhaber","year":"2017","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1080\/17441692.2011.552068","article-title":"Why reinvent the wheel? Leveraging the lessons of HIV scale-up to confront non-communicable diseases","volume":"6","author":"Rabkin","year":"2011","journal-title":"Glob. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/jnci\/djn044","article-title":"Rapid clearance of human papillomavirus and implications for clinical focus on persistent infections","volume":"100","author":"Schiffman","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1086\/315086","article-title":"Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer","volume":"180","author":"Franco","year":"1999","journal-title":"J. Infect. Dis."},{"key":"ref_11","unstructured":"Dean, A.G., Sullivan, K.M., and Soe, M.M. (2021, July 29). OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2. Available online: www.OpenEpi.com."},{"key":"ref_12","unstructured":"Dean, A.G., Sullivan, K.M., and Soe, M.M. (2010). Epi Info and OpenEpi in Epidemiology and Clinical Medicine: Health Applications of Free Software, CreateSpace Independent Publishing Platform."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1525-1497.2004.30091.x","article-title":"The use of \u201coverall accuracy\u201d to evaluate the validity of screening or diagnostic tests","volume":"19","author":"Alberg","year":"2004","journal-title":"J. Gen. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"L49","DOI":"10.1016\/j.vaccine.2008.05.025","article-title":"New approaches to cervical cancer screening in Latin American and the Caribbean","volume":"26","author":"Herrero","year":"2008","journal-title":"Vaccine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1056\/NEJMoa0808516","article-title":"HPV screening for cervical cancer in rural India","volume":"360","author":"Sankaranarayanan","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ijgo.2015.07.026","article-title":"Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia","volume":"132","author":"Santesso","year":"2016","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1001\/jama.294.17.2173","article-title":"Screen-and-treat approaches for cervical cancer prevention in low-resource settings: A randomized controlled trial","volume":"294","author":"Denny","year":"2005","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e020484","DOI":"10.1136\/bmjopen-2017-020484","article-title":"Community-based HPV self-collection versus visual inspection with acetic acid in Uganda: A cost-effectiveness analysis of the ASPIRE trial","volume":"8","author":"Mezei","year":"2018","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.canep.2015.11.008","article-title":"Risk factors associated with human papillomavirus prevalence and cervical neoplasia among Cameroonian women","volume":"40","author":"Catarino","year":"2016","journal-title":"Cancer Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.pvr.2015.05.003","article-title":"When and how often to screen for cervical cancer in three low- and middle-income countries: A cost-effective analysis","volume":"1","author":"Campos","year":"2015","journal-title":"Papillomavirus Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gottschlich, A., Rivera-Andrade, A., Bevilacqua, K., Murchland, A.R., Isak, E., Alvarez, C.S., Ogilvie, G., Carey, T.E., Prince, M., and Dean, M. (2020). Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: A longitudinal analysis. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09478-8"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/ijgo.13538","article-title":"A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis","volume":"153","author":"Sebitloane","year":"2021","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1093\/jnci\/djy225","article-title":"An observational study of deep learning and automated evaluation of cervical images for cancer screening","volume":"111","author":"Hu","year":"2019","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e020432","DOI":"10.1136\/bmjopen-2017-020432","article-title":"Protocol for the study of cervical cancer screening technologies in HIV-infected women living in Rwanda","volume":"8","author":"Murenzi","year":"2018","journal-title":"BMJ Open"},{"key":"ref_25","unstructured":"World Health Organization (WHO) (2021). WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention, World Health Organization. [2nd ed.]."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12406\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:35:52Z","timestamp":1760168152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,25]]},"references-count":25,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182312406"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182312406","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,25]]}}}