Cervical Cancer Screening Cascade for women living with HIV: a cohort study from Zimbabwe

Abstract

Background. We defined a cascade of cervical screening to evaluate the number of women living with HIV (WLHIV) achieving each cascade stage at an HIV care and treatment clinic in Zimbabwe. Methods. We included women aged ≥18 years enrolled at the Newlands Clinic in Harare from June 2012 to June 2017 and followed them until June 2018. The cascade consists of screening and preventative treatment arms based on initial screening results. We report percentages, the median time to reach cascade stages, and cumulative incidence at two years with 95% confidence intervals (CI). Results. A total of 1624 women were included in the study. In the screening arm, the cumulative incidence of cervical screening was 85.4% (95% CI 83.5-87.1) at two years. In the preventative treatment arm, the cumulative incidence of treatment after a positive screening test was 79.5% (95% CI 75.1-83.2) at two years. Half of the treated women received cryotherapy (152/316, 48.1%, median time to treatment=0 days, interquartile range 0-15). The cumulative incidence of testing negative at re-screening after treatment was 36.1% (95% CI 31.2-40.7) at two years. Cervical cancer was diagnosed in 15 women; all were referred for further treatment. Conclusions. Analyzing outcomes along the proposed Cervical Cancer Screening Cascade can identify areas for improvement. Interventions are needed to improve linkage to treatment for screen-positive women who do not qualify for same-day cryotherapy. Many women continued to screen-positive after treatment. Further studies are needed to understand the significance and potential consequences of these positive tests among WLHIV.

Socioeconomic inequalities in cervical pre-cancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe – Analysis of Population-Based HIV Impact Assessment surveys

“…The sample size of females aged 25-49 years ranged from 5882 in Ethiopia to 9186 in Tanzania. The median age and interquartile ranges were 32 years (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) in Ethiopia, 33 years (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) in Zambia and 34 years (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) in Malawi, Rwanda, and Tanzania. The rate of self-reported cervical pre-cancer screening was lowest in Rwanda (3.5% [95% CI 3.1%-4.0%]) and highest in Zambia (17.1% [95% CI 15.8%-18.5%]) and Zimbabwe (17.4% [95% CI 16.1%-18.8%]).…”

“…One reason may be the perception that linking women testing HIV positive to HIV treatment eliminates the risk of cervical pre-cancer for such women. A study in Zimbabwe found that many women living with HIV on ART screened positive for cervical pre-cancer, despite the country attaining HIV treatment targets [33].…”