Prevalence, characteristics, and outcomes of HIV‐positive women diagnosed with invasive cancer of the cervix in Kenya

Abstract

Objective: To determine the prevalence of invasive cervical cancer (ICC) and assess access to, and outcomes of, treatment for ICC among HIV-infected women in Kisumu, Kenya. Methods: We performed a retrospective chart review to identify women diagnosed with ICC between October 2007 and June 2012, and to examine the impact of a change in the referral protocol. Prior to June 2009, all women with ICC were referred to a regional hospital. After this date, women with stage IA1 disease were offered treatment with loop electrosurgical excision procedure (LEEP) in-clinic. Results: Of 4308 women screened, 58 (1.3%) were diagnosed with ICC. The mean age at diagnosis was 34 years (range, 22–50 years). Fifty-four (93.1%) women had stage IA1 disease, of whom 36 (66.7%) underwent LEEP, 7 (12.9%) had a total abdominal hysterectomy, and 11 (20.4%) had unknown or no treatment. At 6, 12, and 24 months after LEEP, 8.0% (2/25), 25.0% (6/24), and 41.2% (7/17) of women had a recurrence of cervical intraepithelial neoplasia 2 or worse, respectively. Conclusion: Most HIV-positive women diagnosed with ICC through screening had early-stage disease. The introduction of LEEP in-clinic increased access to treatment; however, recurrence was high, indicating the need for continued surveillance.

Characteristics and geographic distribution of HIV-positive women diagnosed with cervical cancer in Dar es Salaam, Tanzania

“…Studies from Kenya found that the majority of HIV-positive women, who underwent cervical cancer screening, had stage 1 disease at the time of diagnosis of invasive cervical cancer and this was attributed to the availability of screening. 27 This aspect is consistent with our study, which found the biggest factor associated with cervical cancer disease stage is whether the women were screened or not. However, there was not much difference in cervical cancer disease stage based on the HIV status.…”

Costs of integrating cervical cancer screening at an HIV clinic in Kenya

“…To the best of our knowledge, the present study was the first to estimate the marginal costs of integrating cervical cancer screening into HIV clinics from a societal perspective (including opportunity costs of patients' time) in a Kenyan or Sub‐Saharan African setting. This addresses an existing knowledge gap on the costs of integrating cervical cancer screening into existing public health programs and could assist health systems in leveraging existing resources to increase screening coverage . Additionally, the various scenarios analyzed highlight variations in costs that occur under different model assumptions.…”

“…Studies conducted in the urban center of Nairobi have found the prevalence of HPV infections and high‐grade pre‐cancerous lesions to be 49%–69% and 24%–27% for among women with HIV, respectively; these figures are in comparison with 17% and 8% among women without HIV, respectively . Research performed in Western Kenya has suggested that women living with HIV have a two‐ to four‐fold higher risk of developing cervical cancer compared with women without HIV …”

Cancers in People with HIV and AIDS

“…The mean age at diagnosis was 34 years (range 22-50 years) and 93 % had microscopic disease (stage IA1) (Mungo et al 2013 ). Another retrospective study from South Africa found that HIV-positive women were diagnosed with ICC at a younger age and more advanced stage than HIVnegative women.…”