Diagnostic accuracy of visual inspection with acetic acid versus Papanicolaou smear in cervical cancer screening among HIV-positive women in rural Nigeria.

Cervical cancer remains a significant reproductive and public health concern, particularly among women living with Human Immunodeficiency Virus (HIV) in low-resource settings like Irrua community in Edo State Nigeria. This study aimed to compare the sensitivity and specificity of visual inspection with acetic acid (VIA) and the Papanicolaou smear (Pap smear) as screening methods for premalignant and malignant cervical lesions in HIV-positive women. A comparative cross-sectional design was employed, involving 136 HIV-positive women who met the inclusion criteria. Suspicious or well-defined aceto-white areas observed during VIA were biopsied and subjected to histopathological examination. The sensitivity of VIA was higher than that of the Pap smear (94.1% vs. 73.5%), whereas its specificity was lower (25% vs. 79.5%). When both methods were combined, the screening performance improved, yielding higher sensitivity, specificity, positive predictive value, and negative predictive value (92.3%, 87.5%, 92.3%, and 87.5%, respectively) than either test alone. These findings indicate that VIA demonstrates higher sensitivity than the Pap smear, while using both methods in combination enhances overall diagnostic accuracy. We recommend that VIA can therefore serve as an effective complementary screening tool to the Pap smear for the early detection of cervical cancer, particularly in resource-constrained healthcare settings. Keywords: Cervical cancer, HIV-positive women, Pap smear, Visual Inspection with Acetic Acid (VIA), Screening methods, Sensitivity and specificity, Low-resource settings, Premalignant lesions, Histopathology, Comparative cross-sectional study.