Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

Yimer, Nigus Bililign; Mohammed, Moghniuddin; Solomon, Kalkidan; Tadese, Mesfin; Grutzmacher, Stephanie; Meikena, Henok Kumsa; Alemnew, Birhan; Sharew, Nigussie Tadesse; Habtewold, Tesfa Dejenie

doi:10.1016/j.puhe.2021.04.014

Cited by 85 publications

(89 citation statements)

References 45 publications

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“…Recognizing the devastating impact of cervical cancer on public health, the World Health Assembly passed a resolution in August 2020 to accelerate the elimination of cervical cancer, calling for all member states to adopt multi-sectoral and integrated healthcare approaches aimed at achieving the following triple-intervention coverage targets by 2030; (i) vaccination: 90% of adolescent girls fully vaccinated with the HPV vaccine by the age of 15 years, (ii) screening: 70% of women screened using a high-performance test by the age of 35, and again by the age of 45 years, and (iii) treatment: 90% of women with cervical pre-cancer treated and 90% of women with invasive cervical cancer managed (10). Currently, the pooled uptake of cervical cancer screening services in sub-Saharan Africa is estimated at 12.87% (95% CI: 10.20-15.54) and requires drastic up-scaling if global elimination targets are to be attained (11). In South Africa, the national cervical cancer prevention and management programme is guided by the 2017 Cervical Cancer Prevention and Control Policy (12) which aligns with the current global framework for elimination of cervical cancer and makes careful consideration for the local context including the coburden of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Amponsah-Dacosta

Blose

Nkwinika

et al. 2022

Front. Public Health

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Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.

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Section: Introductionmentioning

confidence: 99%

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Amponsah-Dacosta

Blose

Nkwinika

et al. 2022

Front. Public Health

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“…Staging and treatment procedures for cervical cancer patients in Botswana have been described previously in our previous publication. 5 Concurrent cisplatin was the chemotherapy of choice. Decision to treat with chemoradiation versus radiation was made by the treating physician based on various factors, including renal function, performance status, and anemia.…”

Section: Cervical Cancer Treatmentmentioning

confidence: 99%

“…2 3 This is likely due to higher persistence of human papillomavirus (HPV) infection, 2 4 which is known to be associated with almost all cervical cancer, in patients with HIV compared with patients without HIV, and limited access to cervical cancer screening programs in sub-Saharan Africa. 5 Furthermore, patients with HIV are living longer because antiretroviral therapy is providing a greater opportunity for cervical cancer to develop due to HPV persistence. The higher rates of HPV associated cancers among persons living with HIV further support these theories.…”

Section: Introductionmentioning

confidence: 99%

Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus

Grover

Ning

Bale

et al. 2021

Int J Gynecol Cancer

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ObjectiveCervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status.MethodsBetween February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan–Meier method. Cox proportional hazards modeling was used to analyze associations with survival.ResultsAmong 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01).ConclusionsAddition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.

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“…Over the longer term, this could represent an additional barrier to adherence to the screening programme. This should be a cause for concern because adherence to such programmes tends to be low in WLWH and among migrant women in Europe in particular [8][9][10][11][12]. Lack of information and emotional responses to the test are among the most reported barriers to having a smear in the general population [12,13].…”

Section: Introductionmentioning

confidence: 99%

Re‐valuation of annual cytology using HPV self‐sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK

et al. 2022

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Introduction: Current UK guidelines for cervical cancer screening are based on the assumption that most women living with HIV (WLWH) are also high-risk (HR) human papillomavirus (HPV)-positive. We aimed to provide data on prevalence of HR-HPV in WLWH in the UK and to assess feasibility and acceptability of HR-HPV self-sampling in this group.Methods: Women living with HIV attending six HIV services in London/south of England, with no history of cervical cancer, were enrolled. Participants selfcollected a vaginal swab for the detection of HR-HPV, completed a survey about sexual/gynaecological history, attitudes towards annual screening and perception of HR-HPV self-sampling, and were asked to have their annual cervical smear. University of Oxford) for providing assistance in the project management and Sunita Baniya and Kate Rabjohns (Slough Hospital) for helping with the study delivery.

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Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

Cited by 85 publications

References 45 publications

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?

Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus

Re‐valuation of annual cytology using HPV self‐sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK

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