Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening

Boily, Marie‐Claude; Barnabas, Ruanne V.; Rönn, Minttu M; Bayer, Cara J.; Schalkwyk, Cari van; Soni, Nirali; Rao, Darcy White; Staadegaard, Lisa; Liu, Gui; Silhol, Romain; Brisson, Marc; Johnson, Leigh F.; Bloem, Paul; Gottlieb, Sami L.; Broutet, Nathalie; Dalal, Shona

doi:10.1016/j.eclinm.2022.101754

Cited by 15 publications

(10 citation statements)

References 51 publications

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“…Mathematical models have been instrumental in evaluating and incorporating new technologies into guidelines and health policies worldwide (3–6), and the formulation of the goal to eliminate cervical cancer and the strategies that might get us there has been informed by the results of mathematical models (7–10). HPV vaccination is among the most studied interventions in the public health economics literature, with numerous modeling studies dedicated to evaluating the health impact and cost-effectiveness of the vaccine (11).…”

Section: Overviewmentioning

confidence: 99%

“…The formulation of the goal to eliminate cervical cancer and the strategies that might get us there has been informed by the results of a well-established set of mathematical models (3)(4)(5)(6)(7)(8). Models have also been instrumental in evaluating and incorporating new technologies into guidelines and health policies worldwide (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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HPVsim: An agent-based model of HPV transmission and cervical disease

Stuart

Cohen

Kerr

et al. 2023

Preprint

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In 2020, the WHO launched its first Global Strategy to Accelerate the Elimination of Cervical Cancer, outlining an ambitious set of targets for countries to achieve over the next decade. At the same time, new tools, technologies, and strategies are in the pipeline that may improve screening performance, expand the reach of prophylactic vaccines, and prevent the acquisition, persistence and progression of oncogenic HPV. Detailed mechanistic modeling can help identify the combinations of current and future strategies to combat cervical cancer. Open-source modeling tools are needed to shift the capacity for such evaluations in-country. Here, we introduce the Human papillomavirus simulator (HPVsim), a new, flexible agent-based model that can be parameterized with country-specific vital dynamics, structured sexual networks, co-transmitting HPV genotypes, B- and T-cell mediated immunity, and high-resolution disease natural history. HPVsim is designed with a user-first lens: it is implemented in Python, has built-in tools for simulating commonly-used interventions, includes a comprehensive set of tests and documentation, and runs quickly (seconds to minutes) on a laptop. Useful complexity was not sacrificed: the platform is flexible, allowing bespoke scenario modeling.

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Section: Overviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HPVsim: An agent-based model of HPV transmission and cervical disease

Stuart

Cohen

Kerr

et al. 2023

Preprint

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“…1,3 To achieve the goal of the World Health Organization (WHO) of eliminating CC, countries in sub-Saharan Africa (SSA) must scale up access to primary, secondary, and tertiary prevention measures, especially for girls and WLHIV. [4][5][6] To improve CC control programs, clinicians, researchers, and policymakers need high-quality routine health facility data, 7,8 which can be collected by monitoring each step of the path that people take through the health system. To create a monitoring plan for cancer control, each sequential step through a complex health system must be quantified within the framework of a cascade 9 and indicators must be specified for each step.…”

Section: Introductionmentioning

confidence: 99%

Facility-Based Indicators to Manage and Scale Up Cervical Cancer Prevention and Care Services for Women Living With HIV in Sub-Saharan Africa: a Three-Round Online Delphi Consensus Method

Davidović,

Asangbeh,

Taghavi

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics. Methods: We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3). Results: We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2). Conclusion: We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade.

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“…Recent modeling studies predicted that increasing vaccination or screening frequency for women living with HIV can significantly decrease near-term cervical cancer incidence [ 6 , 13 , 14 ]. A comparative modeling study additionally demonstrated reduced relative cancer incidence among women living with HIV with focused interventions, but assumed idealized coverage levels of precancer and cancer treatment and 100% precancer treatment efficacy [ 15 ]. The impact of cervical cancer interventions tailored by HIV status on the disparity in cancer risk between women with and without HIV, and proportion of cervical cancer cases that are women living with HIV, have yet to be fully quantified.…”

Section: Introductionmentioning

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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Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening

Cited by 15 publications

References 51 publications

HPVsim: An agent-based model of HPV transmission and cervical disease

HPVsim: An agent-based model of HPV transmission and cervical disease

Facility-Based Indicators to Manage and Scale Up Cervical Cancer Prevention and Care Services for Women Living With HIV in Sub-Saharan Africa: a Three-Round Online Delphi Consensus Method

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

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