Guideline Development Tool

Question: Should HPV vs. VIA be used to screen for cervical cancer in [health problem and/or population]?

HPV		VIA
Sensitivity	0.95 (95% CI: 0.84 to 0.98)	Sensitivity	0.69 (95% CI: 0.54 to 0.81)
Specificity	0.84 (95% CI: 0.72 to 0.91)	Specificity	0.87 (95% CI: 0.79 to 0.92)

Prevalences

Outcome	№ of studies (№ of patients)	Study design	Factors that may decrease certainty of evidence					Effect per 1,000 patients tested		Test accuracy CoE
			Factors that may decrease certainty of evidence					pre-test probability of 2%
			Risk of bias	Indirectness	Inconsistency	Imprecision	Publication bias	HPV	VIA
True positives (patients with cervical cancer)	5 studies 406 patients	cross-sectional (cohort type accuracy study)	not serious	not serious	serious ^a	serious ^b	none	19 (17 to 20)	14 (11 to 16)	⨁⨁◯◯ LOW
True positives (patients with cervical cancer)								5 more TP in HPV
False negatives (patients incorrectly classified as not having cervical cancer)								1 (0 to 3)	6 (4 to 9)
								5 fewer FN in HPV
True negatives (patients without cervical cancer)	5 studies 9113 patients	case-control type accuracy study	not serious	not serious	serious ^a	not serious ^c	none	823 (706 to 892)	853 (774 to 902)	⨁⨁⨁◯ MODERATE
True negatives (patients without cervical cancer)								30 fewer TN in HPV
False positives (patients incorrectly classified as having cervical cancer)								157 (88 to 274)	127 (78 to 206)
								30 more FP in HPV

Explanations

a. Unexplained heterogeneity in effects ranging from one side of the threshold to the other

b. Confidence intervals of summary estimates ranged from recommending VIA to recommending HPV

c. Although confidence intervals of summary estimates ranged from recommending VIA to recommending HPV, this was considered to be due to inconsistency. To avoid double counting, the certainty of evidence was not rated down for imprecision.