Challenges and Progress of Policies on Cervical Cancer in South Africa

Jordaan, Suzette; Michelow, Pamela; Simoens, Cindy; Bogers, Johannes

doi:10.4172/2375-4273.1000188

Cited by 4 publications

(6 citation statements)

References 2 publications

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“…Persons with CIN2+ were referred for colposcopic evaluation with biopsy, and women with confirmed lesions or cancer were treated with large loop excision of the transformation zone (LLETZ) or hysterectomy, respectively [ 18 ]. High loss-to-follow-up resulted in low levels of effective treatment with this three-visit strategy [ 19 ]. Effective treatment was lower for women living with HIV, reflecting lower sensitivity and specificity with cytology [ 9 , 10 ] and higher treatment failure (16–23%) compared to women without HIV (9%) [ 12 ] (historic assumptions in Rao et al .…”

Section: Methodsmentioning

confidence: 99%

Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis

Broshkevitch,

Barnabas,

Liu

et al. 2024

PLoS ONE

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Introduction Women living with HIV experience heightened risk of cervical cancer, and over 50% of cases in Southern Africa are attributed to HIV co-infection. Cervical cancer interventions tailored by HIV status delivered with HIV antiretroviral therapy (ART) for treatment can decrease cancer incidence, but impact on HIV-related disparities remains understudied. Methods Using a dynamic model calibrated to KwaZulu-Natal, South Africa, we projected HIV prevalence, cervical cancer incidence, and proportion of cancer cases among women living with HIV between 2021–2071. Relative to the status quo of moderate intervention coverage, we modeled three additive scenarios: 1) ART scale-up only; 2) expanded human papillomavirus (HPV) vaccination, screening, and treatment; and 3) catch-up HPV vaccination and enhanced screening for women living with HIV. Results Under the status quo, HIV prevalence among women aged 15+ decreased from a median of 35% [Uncertainty Range (UR): 26–42%] in 2021 to 25% [19–34%] in 2071. The proportion of cervical cancer cases that were women living with HIV declined from 73% [63–86%] to 58% [47–74%], but incidence remained 4.3-fold [3.3–5.7] that of women without HIV. ART scale-up reduced HIV prevalence in 2071, but increased the incidence rate ratio to 5.2 [3.7–7.3]. Disparities remained after expanding cancer interventions for all women (incidence rate ratio: 4.8 [3.6–7.6]), while additional catch-up HPV vaccination and screening for women living with HIV decreased the incidence rate ratio to 2.7 [1.9–3.4] in 2071. Conclusions Tailored cervical cancer interventions for women living with HIV can counteract rising cancer incidence incurred by extended life expectancy on ART and reduce disparate cancer burden.

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Section: Methodsmentioning

confidence: 99%

Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis

Broshkevitch,

Barnabas,

Liu

et al. 2024

PLoS ONE

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“… 9 , 10 South Africa has set itself the same target of 70% screening coverage; however, this target was not met for the period 2000–2004, nor for the period 2005–2014 according to the National Health Laboratory Service (NHLS) national cytology statistics. 11 , 12 Furthermore, it has been shown that coverage of cervical cancer screening in South Africa may be as low as 19.3%. 2…”

Section: Introductionmentioning

confidence: 99%

“…The South African national guidelines recommend three-yearly screening from the time of HIV diagnosis. 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

An audit of adherence to cervical cancer screening guidelines in a tertiary-level HIV clinic

Bolon,

Samson,

Irwin

et al. 2023

South. Afr. j. HIV med.

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Background: Cervical cancer is the most common malignancy affecting South African women aged 15–44 years, with a higher prevalence among women living with HIV (WLWH). Despite recommendations for a screening target of 70%, the reported rate of cervical cancer screening in South Africa is 19.3%.Objectives: To investigate the adherence of healthcare workers to cervical cancer screening guidelines in a tertiary-level HIV clinic.Method: A retrospective cross-sectional record audit of women attending the Charlotte Maxeke Johannesburg Academic Hospital HIV Clinic over a 1-month period.Results: Out of 403 WLWH who attended the clinic, 180 (44.7%) were screened for cervical cancer in the 3 years prior to the index consultation. Only 115 (51.6%) of those women with no record of prior screening were subsequently referred for screening. Women who had undergone screening in the previous 3 years were significantly older (47 years vs 44 years, P = 0.046) and had a longer time since diagnosis of their HIV (12 years vs 10 years, P = 0.001) compared to women who had not undergone screening. There was no significant difference in CD4 count or viral suppression between women who had and had not undergone screening.Conclusion: The rate of cervical cancer screening in our institution is below that recommended by the World Health Organization and the South African National Department of Health.

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“…8 Poor access to screening, long waiting times for treatment of pre-cancerous cervical lesions as well as the socioeconomic inequities that exist in the country contribute to the high burden of ICC in South Africa. 9,10 Spatiotemporal analysis of ICC incidence among HIV positive women can be used for disease surveillance over time and space, and to identify potential causes of the unequal distribution of ICC incidence. In this nationwide study in South Africa during 2004-2014, we examine the spatiotemporal incidence of ICC among women diagnosed with HIV.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: A nationwide study

Dhokotera

Riou

Bartels

et al. 2020

Preprint

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Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the associated factors among HIV positive women in South Africa. We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004-2014. We used the Thembisa model to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.Novelty and ImpactThis is the first nationwide study in South Africa to evaluate spatial and spatiotemporal distribution of cervical cancer in women diagnosed with HIV. The results show an increased incidence of cervical cancer in affluent municipalities and in those with better access to health care. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers.

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Challenges and Progress of Policies on Cervical Cancer in South Africa

Abstract: Cervical cancer is the second most common cancer in South African women but the most frequently encountered cancer in black women.

Cited by 4 publications

References 2 publications

Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis

Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis

An audit of adherence to cervical cancer screening guidelines in a tertiary-level HIV clinic

Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: A nationwide study

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