Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

Usually VIA-based screening programmes target to screen 30–49 year old women every 3–5 years. Women living with HIV need to start screening at an earlier age (starting at 25) and should undergo screening more frequently. VIA test can be performed during any phase of the menstrual cycle. Pregnancy is not a contraindication for VIA and VIA can be performed up to 20 weeks of pregnancy. However, the test may be technically difficult in advanced pregnancy, because of the hypertrophied cervix and excess mucus and is usually avoided. In a setting that follows ‘screen-and-treat’ approach, every VIA positive woman needs to be evaluated to determine whether she is suitable for ablative treatment (thermal ablation or cryotherapy) and managed accordingly. The steps and criteria to determine eligibility for ablation are discussed in the subsequent sections.

VIA can be used to triage HPV-positive women. HPV-positive women who are also positive on VIA are immediately assessed for eligibility for ablative treatment. Women who are HPV-positive but VIA-negative are advised to repeat HPV test after 2 years. Women living with HIV who are HPV positive and VIA negative are advised to repeat HPV test after 1 year.

VIA can be used to follow up women after treatment for cervical precancers.

The steps of VIA are described in the next sections. Readers can download the step-by-step VIA checklist, which acts as a ready reckoner in the clinic. The checklist is also useful during a VIA training programme, to assess the trainee’s skill.

Click here to download a step-by-step VIA checklist for self-learning.