Integration of cervical cancer screening into HIV/AIDS care in low income countries: a moral imperative

Abstract

Although cervical cancer is preventable, in 2018, approximately 570,000 new cases occurred globally. Cervical cancer disproportionately affects low-and middle-income countries (LMICs), which accounted for 90% of deaths in 2018. Women living with the Human Immunodeficiency Virus (WLWH) are at increased risk of cervical cancer and are in urgent need of prevention. Despite evidence-based guidelines for screening and prevention of cervical cancer, the majority of WLWH in LMICs lack access to cervical cancer screening. Despite tremendous gains made in access to life prolonging antiretroviral therapy for WLWH, most are served by vertical human immunodeficiency virus (HIV) programmes which do not integrate these two crucial services. We present a case of a WLWH, in HIV care for a decade, who was recently diagnosed with preventable, advanced stage cervical cancer.

Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya

“…Our study and numerous others from LMICs have highlighted these access issues. 5,7,8,10,13 In our study, the majority of participants pointed to lower transportation costs as a key reason for preferring self-administration of topical therapies over provider-administration in a health facility. This is further demonstrated by a qualitative study from Malawi where women with abnormal cervical cancer screening results cited lack of transportation and high associated costs as a major reason for not presenting for treatment.…”

“…Current cervical precancer treatment methods include ablation or excision of precancerous lesions, 4 both of which require specialized equipment and trained providers, making access to precancer treatment in LMICs a significant challenge, [5][6][7][8][9][10] resulting in missed opportunities for secondary prevention and diminishing the public health impact of screening. 11 There are high rates of loss-to-follow-up due to cost and transportation challenges when women screened in rural areas are referred to central facilities for treatment, 12 as well as lack of adequate skilled healthcare providers to offer treatment.…”

Real-World Cervical Cancer Screening Uptake and Predictors of Visual Inspection With Acetic Acid Positivity Among Women Living With HIV in Care Programs in Western Kenya

“… 26 The low screening coverages rates are particularly consequential for WLWHIV, many of whom are engaged in HIV care for decades but may be diagnosed with and die of cervical cancer because of lack of screening and precancer treatment. 27 …”

Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

“…This is a more frequent screening interval than the triennial screening recommended for HIV negative women [ 4 ]. The majority of the HIV control interventions in low-resource settings are vertical programmes, with support focusing only on HIV care, antiretroviral therapy (ART) access and viral load suppression, and non to address cervical cancer among WLWH [ 10 ]. The limited access to CCS services within HIV clinics exposes WLWH to preventable cervical cancer-related incidence and mortality thereby eroding the hard-fought gains from access to HIV treatment [ 11 , 12 ].…”