Visual inspection after application of acetic acid (VIA) Ė Advantages of VIA
VIA has several advantages as a screening test or a triage test suitable for resource-limited settings. Traditionally, the Pap smear (cytology) has been the screening test of choice both in high- and low-resource settings. However, cytology-based screening has the following limitations:
VIA can overcome many of the disadvantages of cytology as listed above. The advantages of VIA are the following:
- The test sensitivity (the ability of the test to correctly identify the true positives, i.e. those with high-grade cervical precancer or cancer) is at best moderate (~50%) and can be very low in laboratories that do not have a robust quality assurance process.
- The test is subjective, and the quality depends a lot on the training and expertise of the cytotechnicians or the pathologists.
- Cytology requires laboratory infrastructure, well-trained technicians and pathologists, and stringent quality control at all steps.
- The test results are not immediately available and may be delayed by a few weeks to a few months if there are not enough technicians and pathologists.
- A woman with an abnormal cytology report needs to be further evaluated with colposcopy to confirm the presence of abnormalities, and colposcopy services are scarce in many resource-limited countries.
- Screen-positive women have to make multiple visits for diagnostic confirmation and treatment.
- VIA does not require laboratory infrastructure.
- VIA can be performed by various categories of health personnel (general practitioners, nurses, midwives, etc.) after a short period of training.
- The consumables are affordable and readily available.
- VIA is a truly point-of-care test, and the woman can immediately be informed of the test outcomes; the test-negative women can be reassured and advised.
- Immediate availability of the results enables management of the test-positive women during the same visit.
- The sensitivity of VIA is higher than or similar to that of cytology, especially in resource-limited settings.
- Screening of women with VIA followed by appropriate management of screen-positive women can significantly reduce mortality from cervical cancer, as demonstrated in randomized controlled trials.
However, VIA has certain limitations
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