Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africa a

2020 ◽  
Vol 152 (1) ◽  
pp. 53-59
Author(s):  
Eliane Rohner ◽  
Masangu Mulongo ◽  
Tafadzwa Pasipamire ◽  
Austin M. Oberlin ◽  
Bridgette Goeieman ◽  
...  
Keyword(s):  
South Africa ◽  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Screening Cascade

scholarly journals Cost-Effectiveness of Cervical Cancer Screening in Women Living With HIV in South Africa

2018 ◽  
Vol 79 (2) ◽  
pp. 195-205 ◽  
Author(s):  
Nicole G. Campos ◽  
Naomi Lince-Deroche ◽  
Carla J. Chibwesha ◽  
Cynthia Firnhaber ◽  
Jennifer S. Smith ◽  
...  
Keyword(s):  
South Africa ◽  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Women Living With Hiv ◽  
Living With Hiv

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

2021 ◽  
Author(s):  
Katayoun Taghavi ◽  
Ardele Mandiriri ◽  
Tinei Shamu ◽  
Eliane Rohner ◽  
Lukas Bütikofer ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Median Time ◽  
Cumulative Incidence ◽  
Cervical Screening ◽  
Preventative Treatment ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Screening Cascade

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.

scholarly journals Diagnostic accuracy of cervical cancer screening and screening–triage strategies among women living with HIV-1 in Burkina Faso and South Africa: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003528
Author(s):  
Helen A. Kelly ◽  
Admire Chikandiwa ◽  
Bernard Sawadogo ◽  
Clare Gilham ◽  
Pamela Michelow ◽  
...  
Keyword(s):  
South Africa ◽  
Cervical Cancer ◽  
Cohort Study ◽  
Human Papillomavirus ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
High Grade ◽  
Women Living With Hiv ◽  
Living With Hiv

Background Cervical cancer screening strategies using visual inspection or cytology may have suboptimal diagnostic accuracy for detection of precancer in women living with HIV (WLHIV). The optimal screen and screen–triage strategy, age to initiate, and frequency of screening for WLHIV remain unclear. This study evaluated the sensitivity, specificity, and positive predictive value of different cervical cancer strategies in WLHIV in Africa. Methods and findings WLHIV aged 25–50 years attending HIV treatment centres in Burkina Faso (BF) and South Africa (SA) from 5 December 2011 to 30 October 2012 were enrolled in a prospective evaluation study of visual inspection using acetic acid (VIA) or visual inspection using Lugol’s iodine (VILI), high-risk human papillomavirus DNA test (Hybrid Capture 2 [HC2] or careHPV), and cytology for histology-verified high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) at baseline and endline, a median 16 months later. Among 1,238 women (BF: 615; SA: 623), median age was 36 and 34 years (p < 0.001), 28.6% and 49.6% ever had prior cervical cancer screening (p < 0.001), and 69.9% and 64.2% were taking ART at enrolment (p = 0.045) in BF and SA, respectively. CIN2+ prevalence was 5.8% and 22.4% in BF and SA (p < 0.001), respectively. VIA had low sensitivity for CIN2+ (44.7%, 95% confidence interval [CI] 36.9%–52.7%) and CIN3+ (56.1%, 95% CI 43.3%–68.3%) in both countries, with specificity for ≤CIN1 of 78.7% (95% CI 76.0%–81.3%). HC2 had sensitivity of 88.8% (95% CI 82.9%–93.2%) for CIN2+ and 86.4% (95% CI 75.7%–93.6%) for CIN3+. Specificity for ≤CIN1 was 55.4% (95% CI 52.2%–58.6%), and screen positivity was 51.3%. Specificity was higher with a restricted genotype (HPV16/18/31/33/35/45/52/58) approach (73.5%, 95% CI 70.6%–76.2%), with lower screen positivity (33.7%), although there was lower sensitivity for CIN3+ (77.3%, 95% CI 65.3%–86.7%). In BF, HC2 was more sensitive for CIN2+/CIN3+ compared to VIA/VILI (relative sensitivity for CIN2+ = 1.72, 95% CI 1.28–2.32; CIN3+: 1.18, 95% CI 0.94–1.49). Triage of HC2-positive women with VIA/VILI reduced the number of colposcopy referrals, but with loss in sensitivity for CIN2+ (58.1%) but not for CIN3+ (84.6%). In SA, cytology high-grade squamous intraepithelial lesion or greater (HSIL+) had best combination of sensitivity (CIN2+: 70.1%, 95% CI 61.3%–77.9%; CIN3+: 80.8%, 95% CI 67.5%–90.4%) and specificity (81.6%, 95% CI 77.6%–85.1%). HC2 had similar sensitivity for CIN3+ (83.0%, 95% CI 70.2%–91.9%) but lower specificity compared to HSIL+ (42.7%, 95% CI 38.4%–47.1%; relative specificity = 0.57, 95% CI 0.52–0.63), resulting in almost twice as many referrals. Compared to HC2, triage of HC2-positive women with HSIL+ resulted in a 40% reduction in colposcopy referrals but was associated with some loss in sensitivity. CIN2+ incidence over a median 16 months was highest among VIA baseline screen-negative women (2.2%, 95% CI 1.3%–3.7%) and women who were baseline double-negative with HC2 and VIA (2.1%, 95% CI 1.3%–3.5%) and lowest among HC2 baseline screen-negative women (0.5%, 95% CI 0.1%–1.8%). Limitations of our study are that WLHIV included in the study may not reflect a contemporary cohort of WLHIV initiating ART in the universal ART era and that we did not evaluate HPV tests available in study settings today. Conclusions In this cohort study among WLHIV in Africa, a human papillomavirus (HPV) test targeting 14 high-risk (HR) types had higher sensitivity to detect CIN2+ compared to visual inspection but had low specificity, although a restricted genotype approach targeting 8 HR types decreased the number of unnecessary colposcopy referrals. Cytology HSIL+ had optimal performance for CIN2+/CIN3+ detection in SA. Triage of HPV-positive women with HSIL+ maintained high specificity but with some loss in sensitivity compared to HC2 alone.

scholarly journals Impact of cervicitis on performance of cervical cancer screening using HRHPV testing and visual evaluation in women living with HIV in Botswana

2020 ◽  
Vol 151 (1) ◽  
pp. 144-146
Author(s):  
Helena Painter ◽  
Adrienne Erlinger ◽  
Boikhutso Simon ◽  
Chelsea Morroni ◽  
Doreen Ramogola‐Masire ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Visual Evaluation ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Comprehensive knowledge and uptake of cervical cancer screening is low among women living with HIV/AIDS in Northwest Ethiopia

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Daniel Asfaw Erku ◽  
Adeladlew Kassie Netere ◽  
Amanual Getnet Mersha ◽  
Sileshi Ayele Abebe ◽  
Abebe Basazn Mekuria ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Northwest Ethiopia ◽  
Women Living With Hiv ◽  
Comprehensive Knowledge ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Costs and cost-effectiveness of cervical cancer screening strategies in women living with HIV in Burkina Faso: The HPV in Africa Research Partnership (HARP) study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248832
Author(s):  
Angela Devine ◽  
Alice Vahanian ◽  
Bernard Sawadogo ◽  
Souleymane Zan ◽  
Fadima Yaya Bocoum ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Burkina Faso ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Screening Tests ◽  
Research Partnership ◽  
Women Living With Hiv ◽  
Screening Strategies ◽  
Living With Hiv

Introduction This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. Methods The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol’s iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). Results The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31–41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cytology. Compared to VIA alone, the incremental cost per CIN2+ case detected was US$48 for VIA/VILI and US$814 for careHPV. Despite higher costs, careHPV was more sensitive for CIN2+ cases detected compared to VIA/VILI (97% and 56%, respectively). The cost of colposcopy was US$6.6 per person while directed biopsy was US$33.0 and 4Q biopsy was US$48.0. Conclusion Depending on the willingness to pay for the detection of a case of cervical cancer, decision makers in Burkina Faso can consider a variety of cervical cancer screening strategies for WLHIV. While careHPV is more costly, it has the potential to be cost-effective depending on the willingness to pay threshold. Future research should explore the lifetime costs and benefits of cervical cancer screening to enable comparisons with interventions for other diseases.

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