Visual Inspection with Acetic Acid (VIA) Versus Visual Inspection with Lugol’s Iodine (VILI) for Cervical Cancer Screening in Rural Settings: A Comprehensive Review

Abstract

Cervical cancer disproportionately affects women in rural low- and middle-income countries (LMICs), where access to cytology, colposcopy, and follow‑up care is limited. Visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) are low‑cost tests that provide immediate results and can be used within single‑visit “screen‑and‑treat” models delivered by trained non‑physician providers. This narrative review synthesizes global guidance and empirical evidence—diagnostic accuracy, programmatic effectiveness, cost, and practical implementation—comparing VIA and VILI in rural set‑ups. Meta‑analyses and head‑to‑head cross‑sectional studies indicate that both methods have moderate accuracy for detecting CIN2+, with several analyses showing higher pooled sensitivity for VILI than VIA at roughly similar specificity [4,5]. Randomized and cluster‑randomized trials demonstrate population‑level benefits of visual screening when programs ensure treatment linkages; however, contemporary WHO recommendations prioritize primary HPV testing, using VIA (and, where available, VILI) mainly for triage or as interim options during HPV scale‑up [1,2]. Overall, the choice between VIA and VILI matters less than investment in training, quality assurance (QA), procurement reliability, and same‑day ablative treatment access. We conclude with a pragmatic algorithm tailored to rural programs, emphasizing phased HPV integration, VIA/VILI triage, and monitoring of overtreatment alongside equity and acceptability considerations [1,8–11].