Estimating the burden of cervical disease among HIV-infected women accessing screening services in South Africa: A model-based analysis

Abstract

Background. Cervical cancer remains the second most common cancer among women worldwide, with much of the global burden occurring in low-and middle-income countries. HIV-infected women are at increased risk of human papillomavirus infection, preinvasive cervical disease and invasive cervical cancer (ICC). Funded through the United States President's Emergency Plan for AIDS Relief (PEPFAR) and working in collaboration with the South African (SA) Department of Health, our team supports cervical screening integrated within public sector HIV clinics in SA. Objectives. To estimate the burden of cervical disease among HIV-infected women accessing screening services supported through our programme. Methods. We constructed conditional probability models to estimate the burden of grade 1 and grades 2/3 cervical intraepithelial lesions (CIN1 and CIN2/3) and ICC among two cohorts: one consisting of 3 190 HIV-infected women for whom only cytology results were available for analysis, and another consisting of 75 358 HIV-infected women for whom neither cytology nor histology results were available. Parameter estimates for the models were derived from routinely collected programmatic data and published clinical trials. Results. Between January 2009 and November 2015, 75 358 HIV-infected women underwent Pap smear screening in public sector clinics supported by our cervical cancer prevention programme. Based on modelling analysis, we estimate that 46 123 cases of CIN1 (range 45 500 -49 608), 13 598 cases of CIN2/3 (range 12 749 -14 828), and 104 cases of ICC (range 61 -186) occurred in this population. Conclusions. Our findings highlight the magnitude of cervical disease among HIV-infected women in SA.

Exploring women's preferences for HPV‐based cervical cancer screening in South Africa

“…One of the study sites was a hospital‐based clinic co‐located with a large public‐sector HIV treatment program, which provides cervical cancer screening and treatment of precancerous lesions to approximately 3000 women infected with HIV annually. The second site was a mobile clinic, which provides screening services to 2000 women in one of Johannesburg's poorest townships each year …”

Cervical cancer in low and middle‑income countries (Review)

“…South Africa has the highest age-standardised incidence of cervical cancer globally, with 32 cases per 100,000 women (22), whereas Paraguay (a middle-income country) has the highest incidence (34.2 per 100,000 women) and a mortality rate of 15.7 per 100,000 women (21,23). These results indicated that women infected with HIV may be at a higher risk of developing HPV infection, pre-invasive cervical disease and invasive cervical cancer (ICC) (18,24,25). Currently, South Africa has the highest incidence of HIV infection worldwide, with ~7.2 million cases in a population of 58 million (26); an estimated 13 million women are infected with HIV in sub-Saharan Africa (25,27).…”

Distribution and trends of cancer in Buffalo City, Eastern Cape Province, 1991-2009: a retrospective study

“…The natural history of cervical cancer has been studied, and it has been concluded that the persistent infection of the cervix by the oncogenic types of Human papillomavirus (HPV 16 & HPV 18) is the necessary cause in 72% of cervical cancers in Africa [ 11 , 31 ]. South Africa is reported to be home to the largest number of HIV-infected individuals, with nearly 60% of incident HIV infections occurring in women [ 32 - 34 ]. Previously performed systematic reviews and analysis have showed that the overall risk of HIV acquisition in women doubled when they had a prevalent HPV infection with any genotype, and that HIV acquisition was significantly associated with any HPV infection [ 35 - 37 ].…”