The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study

Abstract

IntroductionWe aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.MethodsMathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, and engaged in care (numbers screened, treated and cured) and five yearly age-standardised incidence.ResultsAll options will reduce CC cases and deaths compared with no scale-up. Options 1–3 will perform similarly, averting approximately 28 000 (33%) CC cases and 7700 (27%) deaths. That is, VIA screening would yield minimal losses to follow-up (LTFU). Conversely, LTFU associated with HPV-DNA testing will yield a lower care engagement, despite better diagnostic performance. In contrast, option 4 would maximise health outcomes, averting 43 200 (50%) CC cases and 11 800 (40%) deaths, given greater care engagement. Yearly rescreening with either option will impose a substantial burden on the health system, which could be reduced by spacing out frequency to three yearly without undermining health gains.ConclusionsBeyond the specific choice of technologies to scale up, efficiently using available options will drive programmatic success. Addressing practical constraints around diagnostics’ performance and LTFU will be key to effectively avert CC cases and deaths.

Mathematical Models for Evaluating Effectiveness and Cost-Effectiveness of Cervical Cancer Control Policies in Populations Including Women Living With Human Immunodeficiency Virus: A Scoping Review

“…Thirteen studies (59%) conducted cost-effectiveness analyses (CEAs), and 9 (41%) examined the effectiveness of different prevention strategies on cervical cancer incidence or mortality. Fourteen studies (64%) were based on adaptations of previous modeling work: of these, 9 studies 15,16,18,25,28,[30][31][32][33] built on published HIV, HPV, or cervical cancer models and 5 studies 14,22,24,27,35 were adaptations of already included models. 19,20,23,31 Most studies compared cervical cancer prevention strategies in 1 country; 18 (82%) focused on African countries (Fig.…”

“…Two studies 18,25 used broad categories such as cancer (any stage), cured cancer, or cancer-related death. For 1 study, 28 the cancer staging remained unclear. Only 4 studies assumed that cervical cancer progression varied by HIV status.…”

“…Supplemental material was available for 13 studies (59%), giving additional information on model estimation and validation, model structure, or results. Sixteen articles (73%) were open access publications, but only 1 study 28 made the model code available upon request.…”

Impact of catch-up human papillomavirus vaccination on cervical cancer incidence in Kenya: A mathematical modeling evaluation of HPV vaccination strategies in the context of moderate HIV prevalence

“…Increasing screening coverage and treatment retention would prevent cancer among unvaccinated women and prevent cervical cancer caused by HPV types not targeted by the vaccine. 26 A strength of our model is that HIV and HPV transmission occurred dynamically, allowing the model to capture herd effects from interventions. This enabled us to estimate the total, population-level effect of vaccination on cervical cancer in Kenya.…”

Strengthening global commitment to eliminating cervical cancer: What lessons from the past can we apply to the future?

“…At the global level, there is evidence that the inequities in access to health care in the non-communicable diseases (NCDs) era, and specifically relating to CC, are being acknowledged [ 17 ]. The WHO has initiated a campaign to increase awareness and initiate action from member states to prioritize vaccination and screening programs.…”