Comparative Performance and Concordance of VIA, Cytology, and HPV Molecular Assays for Cervical Cancer Screening in Taraba State, Nigeria

Abstract

Cervical cancer remains the fourth most common cancer among women worldwide and a major cause of morbidity and mortality in low- and middle-income countries (LMICs), including Nigeria. Persistent infection with high-risk human papillomavirus (hrHPV), particularly HPV-16 and HPV-18, is the principal cause of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer. Despite its preventable nature, limited access to screening contributes to late diagnosis, particularly in underserved communities such as those in Taraba State, Nigeria. This study aimed to compare the screening performance and concordance of Visual Inspection with Acetic Acid (VIA), Pap smear cytology, Nested PCR, and the Aptima HPV Assay among women in Taraba State. A cross-sectional diagnostic accuracy study was conducted across four Local Government Areas in Taraba State. The minimum calculated sample size was 369 participants. A total of 432 women aged 25–65 years with complete results for the principal screening procedures were included in the final analytical dataset. Among 46 successfully genotyped HPV-positive samples, ten HPV genotypes were identified, comprising six high-risk and four low-risk types; HPV-16 (19.5%) and HPV-18 (17.4%) were the most frequently detected high-risk genotypes, and multiple HPV infections were also identified. The findings indicate differences in screening performance and concordance among the evaluated methods, with Pap smear showing the highest observed agreement in this study and molecular assays providing complementary information on HPV detection. The findings support integrated, context-appropriate cervical cancer screening strategies and targeted HPV vaccination, while recognizing that the absence of histopathological confirmation limits conclusions regarding definitive diagnostic accuracy.