These recommendations apply to all women regardless of HIV status, but specific recommendations for women living with HIV have been developed.
The expert panel1
recommends against the use of CKC as a treatment in a screen-and-treat strategy. Therefore, all screen-and-treat strategies below involve treatment with cryotherapy, or LEEP when the patient is not eligible for cryotherapy.
The expert panel suggests:
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Use a strategy of screen with an HPV test and treat, over a strategy of screen with VIA and treat. In resource-constrained settings, where screening with an HPV test is not feasible, the panel suggests a strategy of screen with VIA and treat.
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Use a strategy of screen with an HPV test and treat, over a strategy of screen with cytology followed by colposcopy (with or without biopsy) and treat. However, in countries where an appropriate/high-quality screening strategy with cytology followed by colposcopy already exists, either an HPV test or cytology followed by colposcopy could be used.
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Use a strategy of screen with VIA and treat, over a strategy of screen with cytology followed by colposcopy (with or without biopsy) and treat. The recommendation for VIA over cytology followed by colposcopy can be applied in countries that are currently considering either programme or countries that currently have both programmes available.
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Use a strategy of screen with an HPV test and treat, over a strategy of screen with an HPV test followed by colposcopy (with or without biopsy) and treat.
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Use either a strategy of screen with an HPV test followed by VIA and treat, or a strategy of screen with an HPV test and treat.
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Use a strategy of screen with an HPV test followed by VIA and treat, over a strategy of screen with VIA and treat.
- ▸
Use a strategy of screen with an HPV test followed by VIA and treat, over a strategy of screen with cytology followed by colposcopy (with or without biopsy) and treat.
- ▸
Use a strategy of screen with an HPV test followed by VIA and treat, over a strategy of screen with an HPV test followed by colposcopy (with or without biopsy) and treat.
- 1
The expert panel includes all members of the WHO Steering Group, the Guideline Development Group (GDG), and the External Review Group (ERG)
As shown below, a decision-making flowchart has been developed that will assist programme managers to choose one of the suggested strategies, depending on the context where it will be implemented (also provided in Annex 2). Details about the flow of each different strategy are also presented in the flowcharts in Annex 3 (for women of negative or unknown HIV status) and Annex 4 (for women of HIV-positive status or unknown HIV status in areas with high endemic HIV infection).
Decision-making flowchart for programme managers (PDF, 407K)
