Factors associated with a cervical high‐grade lesion on cytology or a positive visual inspection with acetic acid among more than 3300 Tanzanian women

Objectives Cervical cancer screening by visual inspection with acetic acid ( VIA ) is a widely used alternative to cytology in developing countries. This study aimed to evaluate risk factors associated with a positive VIA test and with cervical high‐grade lesions on cytology. Methods We conducted a large cross‐sectional study among 3339 women from urban and rural Tanzania. Study participants were interviewed about socio‐demographic, reproductive and lifestyle factors. Blood samples were tested for HIV , and a gynaecological examination was performed. Human papillomavirus ( HPV ) status was determined by Hybrid Capture 2, and HPV genotyping was done using the Li PA Extra test. We used multivariable logistic regression to estimate adjusted odds ratios ( OR s) and confidence intervals ( CI s). Results The strongest risk factors for VIA positivity were positivity to HIV ( OR  = 3.48; 95% CI : 2.34–5.17) or to high‐risk HPV (Hr HPV ) ( OR  = 1.97; 95% CI : 1.37–2.85). Hr HPV was by far the strongest predictor of high‐grade cytology ( OR  = 110.1; 95% CI : 50.4–240.4), while there was no significant association with HIV in the multivariable analysis ( OR  = 1.27; 95% CI : 0.78–2.08). After adjustment for Hr HPV , HIV and age, the risk of high‐grade cytology also increased with increasing age, number of births and low body mass index ( BMI ), while high BMI decreased the risk of VIA positivity. Conclusions Infection with Hr HPV is a major risk factor for high‐grade cytology, while VIA positivity is associated with HIV and to a lesser extent with Hr HPV .