Comparison of Cervical Cancer Screening Tests in HIV-infected Women in Lusaka, Zambia

Cervical Cancer Clinical Trial

Official title:

Z 1313 - Comparison of Point-of-care Molecular Tests and Visual Inspection With Acetic Acid for Cervical Cancer Screening in HIV-infected Women in Lusaka, Zambia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02688816
• Other study ID #: 14-0399
• Secondary ID: 3 D43 CA15378403
• Status: Completed
• Phase: N/A
• First received: February 11, 2016
• Last updated: February 17, 2016
• Start date: August 2014
• Est. completion date: June 2015

Study information

• Verified date: February 2016
• Source: University of North Carolina, Chapel Hill
• Contact: n/a
• Is FDA regulated: No
• Health authority: Zambia: Ministry of HealthZambia: Research Ethics CommitteeUnited States: Institutional Review Board
• Study type: Observational

Clinical Trial Summary

This study will compare the test performance characteristics of visual inspection with acetic acid (VIA), Xpert HPV, and OncoE6 in HIV-infected women, to inform the possible inclusion of these molecular tests in future cervical cancer screening

Description:

This is a cross-sectional study taking place at cervical cancer prevention clinics in Lusaka, Zambia to determine the test performance characteristics (sensitivity, specificity, positive predictive value, and negative predictive value) of (1) visual inspection with acetic acid, (2) Xpert HPV, and (3) OncoE6 for the detection of CIN2+ among HIV-infected women. All cervical screening tests will be evaluated against a gold standard of histopathology obtained from cervical biopsies.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 200
• Est. completion date: June 2015
• Est. primary completion date: June 2015
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Women 18 years and older.

• Women with documented HIV-infection in their medical record or by on-site testing through voluntary counseling and testing.

• Women willing to undergo pelvic examination and cervical cancer screening.

• Women willing to provide written, informed consent.

Exclusion Criteria:

• Pregnancy

Study Design

Observational Model: Cohort, Time Perspective: Cross-Sectional

Related Conditions & MeSH terms

• Cervical Cancer
• Uterine Cervical Neoplasms

Intervention

Device:
• Xpert HPV
Point-of-care HPV DNA PCR test
• OncoE6
Point-of-care E6 oncoprotein test

Locations

Country	Name	City	State
Zambia	Adult Infectious Disease Centre at the University Teaching Hospital	Lusaka

Sponsors (2)

Lead Sponsor	Collaborator
Carla Chibwesha, MD	National Cancer Institute (NCI)

Country where clinical trial is conducted

Zambia, 

References & Publications (24)

Abreu AL, Souza RP, Gimenes F, Consolaro ME. A review of methods for detect human Papillomavirus infection. Virol J. 2012 Nov 6;9:262. doi: 10.1186/1743-422X-9-262. Review. — View Citation

Andersson S, Dillner L, Elfgren K, Mints M, Persson M, Rylander E. A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities. Acta Obstet Gynecol Scand. 2005 Oct;84(10):996-1000. — View Citation

Bosch FX, Manos MM, Muñoz N, Sherman M, Jansen AM, Peto J, Schiffman MH, Moreno V, Kurman R, Shah KV. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995 Jun 7;87(11):796-802. — View Citation

Davidson M, Schnitzer PG, Bulkow LR, Parkinson AJ, Schloss ML, Fitzgerald MA, Knight JA, Murphy CM, Kiviat NB, Toomey KE, et al. The prevalence of cervical infection with human papillomaviruses and cervical dysplasia in Alaska Native women. J Infect Dis. 1994 Apr;169(4):792-800. — View Citation

Elfgren K, Kalantari M, Moberger B, Hagmar B, Dillner J. A population-based five-year follow-up study of cervical human papillomavirus infection. Am J Obstet Gynecol. 2000 Sep;183(3):561-7. — View Citation

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010 Dec 15;127(12):2893-917. doi: 10.1002/ijc.25516. — View Citation

Folpe AL, Agoff SN, Willis J, Weiss SW. Parachordoma is immunohistochemically and cytogenetically distinct from axial chordoma and extraskeletal myxoid chondrosarcoma. Am J Surg Pathol. 1999 Sep;23(9):1059-67. — View Citation

Goel A, Gandhi G, Batra S, Bhambhani S, Zutshi V, Sachdeva P. Visual inspection of the cervix with acetic acid for cervical intraepithelial lesions. Int J Gynaecol Obstet. 2005 Jan;88(1):25-30. — View Citation

Gravitt PE, Paul P, Katki HA, Vendantham H, Ramakrishna G, Sudula M, Kalpana B, Ronnett BM, Vijayaraghavan K, Shah KV; CATCH Study Team. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PLoS One. 2010 Oct 28;5(10):e13711. doi: 10.1371/journal.pone.0013711. — View Citation

Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007 Jul 7;370(9581):59-67. Review. — View Citation

Manos MM, Kinney WK, Hurley LB, Sherman ME, Shieh-Ngai J, Kurman RJ, Ransley JE, Fetterman BJ, Hartinger JS, McIntosh KM, Pawlick GF, Hiatt RA. Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA. 1999 May 5;281(17):1605-10. — View Citation

Miller AB, Nazeer S, Fonn S, Brandup-Lukanow A, Rehman R, Cronje H, Sankaranarayanan R, Koroltchouk V, Syrjänen K, Singer A, Onsrud M. Report on consensus conference on cervical cancer screening and management. Int J Cancer. 2000 May 1;86(3):440-7. Review. — View Citation

Mwanahamuntu MH, Sahasrabuddhe VV, Blevins M, Kapambwe S, Shepherd BE, Chibwesha C, Pfaendler KS, Mkumba G, Vwalika B, Hicks ML, Vermund SH, Stringer JS, Parham GP. Utilization of cervical cancer screening services and trends in screening positivity rates in a 'screen-and-treat' program integrated with HIV/AIDS care in Zambia. PLoS One. 2013 Sep 18;8(9):e74607. doi: 10.1371/journal.pone.0074607. eCollection 2013. — View Citation

Mwanahamuntu MH, Sahasrabuddhe VV, Kapambwe S, Pfaendler KS, Chibwesha C, Mkumba G, Mudenda V, Hicks ML, Vermund SH, Stringer JS, Parham GP. Advancing cervical cancer prevention initiatives in resource-constrained settings: insights from the Cervical Cancer Prevention Program in Zambia. PLoS Med. 2011 May;8(5):e1001032. doi: 10.1371/journal.pmed.1001032. Epub 2011 May 17. — View Citation

Mwanahamuntu MH, Sahasrabuddhe VV, Pfaendler KS, Mudenda V, Hicks ML, Vermund SH, Stringer JS, Parham GP. Implementation of 'see-and-treat' cervical cancer prevention services linked to HIV care in Zambia. AIDS. 2009 Mar 27;23(6):N1-5. doi: 10.1097/QAD.0b013e3283236e11. — View Citation

Ngan HY, Garland SM, Bhatla N, Pagliusi SR, Chan KK, Cheung AN, Chu TY, Domingo EJ, Qiao YL, Park JS, Tay EH, Supakarapongkul W. Asia oceania guidelines for the implementation of programs for cervical cancer prevention and control. J Cancer Epidemiol. 2011;2011:794861. doi: 10.1155/2011/794861. Epub 2011 Apr 13. — View Citation

Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006 Jun 15;118(12):3030-44. — View Citation

Poljak M, Kocjan BJ. Commercially available assays for multiplex detection of alpha human papillomaviruses. Expert Rev Anti Infect Ther. 2010 Oct;8(10):1139-62. doi: 10.1586/eri.10.104. Review. — View Citation

Roden R, Wu TC. How will HPV vaccines affect cervical cancer? Nat Rev Cancer. 2006 Oct;6(10):753-63. Review. — View Citation

Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, Hingmire S, Malvi SG, Thorat R, Kothari A, Chinoy R, Kelkar R, Kane S, Desai S, Keskar VR, Rajeshwarkar R, Panse N, Dinshaw KA. HPV screening for cervical cancer in rural India. N Engl J Med. 2009 Apr 2;360(14):1385-94. doi: 10.1056/NEJMoa0808516. — View Citation

Schiffman MH, Castle P. Epidemiologic studies of a necessary causal risk factor: human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst. 2003 Mar 19;95(6):E2. Review. — View Citation

Schweizer J, Lu PS, Mahoney CW, Berard-Bergery M, Ho M, Ramasamy V, Silver JE, Bisht A, Labiad Y, Peck RB, Lim J, Jeronimo J, Howard R, Gravitt PE, Castle PE. Feasibility study of a human papillomavirus E6 oncoprotein test for diagnosis of cervical precancer and cancer. J Clin Microbiol. 2010 Dec;48(12):4646-8. doi: 10.1128/JCM.01315-10. Epub 2010 Oct 6. — View Citation

Vedantham H, Silver MI, Kalpana B, Rekha C, Karuna BP, Vidyadhari K, Mrudula S, Ronnett BM, Vijayaraghavan K, Ramakrishna G, Sowjanya P, Laxmi S, Shah KV, Gravitt PE; CATCH Study Team. Determinants of VIA (Visual Inspection of the Cervix After Acetic Acid Application) positivity in cervical cancer screening of women in a peri-urban area in Andhra Pradesh, India. Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1373-80. doi: 10.1158/1055-9965.EPI-09-1282. — View Citation

Zhao FH, Lewkowitz AK, Chen F, Lin MJ, Hu SY, Zhang X, Pan QJ, Ma JF, Niyazi M, Li CQ, Li SM, Smith JS, Belinson JL, Qiao YL, Castle PE. Pooled analysis of a self-sampling HPV DNA Test as a cervical cancer primary screening method. J Natl Cancer Inst. 2012 Feb 8;104(3):178-88. doi: 10.1093/jnci/djr532. Epub 2012 Jan 23. — View Citation

* Note: There are 24 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of VIA-, Xpert HPV-, and OncoE6-positive results that are correctly identified	True positive rate (i.e., sensitivity) for CIN2+	once, at the enrollment visit	No
Primary	Proportion of VIA-, Xpert HPV-, and OncoE6-negative results that are correctly identified	True negative rate (i.e., specificity) for CIN2+	once, at the enrollment visit	No

External Links

•   University of North Carolina website