Browsing by Author "Madliwa, Thamsanqa"

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Accuracy of screening tests for cervical precancer in women living with HIV in low-resource settings: a paired prospective study in Lusaka, Zambia.
(2024) Taghavi, Katayoun; Moono, Misinzo; Mwanahamuntu, Mulindi; Roumet, Marie; Limacher, Andreas; Kapesa, Herbert; Madliwa, Thamsanqa; Rutjes, Anne; Basu, Partha; Low, Nicola; Manasyan, Albert; Bohlius, Julia
OBJECTIVE: This study aimed to provide evidence to improve cervical screening for women living with HIV (WLHIV). We assessed the accuracy of screening tests that can be used in low-resource settings and give results at the same visit. METHODS AND ANALYSIS: We conducted a paired, prospective study among consecutive eligible WLHIV, aged 18-65 years, receiving cervical cancer screening at one hospital in Lusaka, Zambia. The histopathological reference standard was multiple biopsies taken at two time points. The target condition was cervical intraepithelial neoplasia grade 2 and above (CIN2+). The index tests were high-risk human papillomavirus detection (hrHPV, Xpert HPV, Cepheid), portable colposcopy (Gynocular, Gynius) and visual inspection with acetic acid (VIA). Accuracy of stand-alone and test combinations were calculated as the point estimate with 95% CIs. A sensitivity analysis considered disease when only visible lesions were biopsied. RESULTS: Women included in the study had well-controlled HIV infection (median CD4 count=542 cells/mm CONCLUSION: The low accuracy of screening tests assessed might be explained by our reference standard, which reduced verification and misclassification biases. Better screening strategies for WLHIV in low-resource settings are urgently needed. TRIAL REGISTRATION NUMBER: NCT03931083.
Cervical intraepithelial neoplasia progression and regression among women living with HIV in Zambia
(2025-10-16) Andoh, John; Taghavi, Katayoun; Moono, Misinzo; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Low, Nicola; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia. Methods: Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression. Results: Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment. Conclusions: Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
Human papillomavirus detection in liquid-based cytology and cervical histology samples among women living with human immunodeficiency virus in Zambia
(2026-08-11) Taghavi, Katayoun; Moono, Misinzo; Villalobos, Nathalie V. F.; Andoh, John; Glass, Allison; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Manasyan, Albert; Rohner, Eliane
Abstract Objectives: Cervicovaginal human papillomavirus (HPV) prevalence is high among women living with human immunodeficiency virus (WLHIV), but not all HPV genotypes detected in liquid-based cytology (LBC) may be present in cervical tissue. We explored HPV genotype concordance in paired LBC and histology samples among WLHIV in Zambia. Methods: WLHIV aged 18-65 years who were enrolled in a cervical screening test accuracy study were invited for follow-up after 30-36 months. LBC samples and two or more cervical biopsies were collected and tested for 28 HPV genotypes (Anyplex II/Allplex HPV28, Seegene, South Korea). HPV prevalence and genotype-specific agreement were assessed using Cohen's kappa. Results: From April 2022 to May 2023, 242 WLHIV (22 with high-grade squamous intraepithelial lesions) had valid paired HPV results. The prevalence of any HPV was similar on LBC (39%) and histology (34%). Multiple-type infections were more common on LBC (18%) than on histology (10%). HPV 16 was the most frequent genotype: 9% (n = 22) on LBC, and 15% (n = 36) on histology. Agreement for any high-risk HPV genotype was 66.1% (kappa = 0.27). Conclusions: Among Zambian WLHIV with mostly low-grade cervical lesions, LBC showed more multiple-type HPV infections and limited agreement with histology samples, possibly reflecting transient infections detected by LBC. The frequent detection of HPV 16 in histology samples but not in LBC warrants further investigation.