Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment / Activity 1

The HPV detection test may be used in the context of a screen-and-treat approach, which implies that all HPV-positive women should be considered for treatment, irrespective of whether an abnormality is visible on the cervix. The selection of the most suitable type of treatment (ablation, excision, or cancer-directed) will be based on the findings after application of dilute acetic acid. This is different from VIA screening or VIA triage, in which treatment is considered only if there is a visible lesion. The details of the criteria are discussed later.

HPV-positive women need to be recalled for a pelvic examination, during which 5% acetic acid is applied to the cervix and eligibility for ablative treatment is determined on the basis of certain criteria, to be discussed later. Any of the available magnification devices may be used to see the features on the cervix better. All women will receive some form of treatment – those who are eligible for ablation will be treated by cryotherapy or thermal ablation, and those who are not suitable for ablation will be treated by excision.

When VIA is used to triage HPV-positive women, only those positive on both the HPV test and VIA should be assessed for treatment. The VIA provider should immediately decide whether the cervix can be treated by thermal ablation or cryotherapy, using the same set of criteria.