Background:
At 54.8 cases per 100,000 women, Uganda is one of the highest cervical cancer (CxCa) burdened countries in the world. Women living with HIV (WLHIV) are 6 times greater risk of developing CxCa, compared to women without HIV. To reduce the occurrence of CxCa among WLHIV, the Uganda Ministry of Health (MOH), with support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the PEPFAR agencies (CDC, USAID, DOD) and Implementing Partners, began a CxCa screening and treatment of pre-cancerous lesions program in October 2020. Here, we describe initial program performance and implications for national scale-up.
Methods:
We supported the design, development and printing of standards, guidelines and monitoring and evaluation tools for the program; we also trained national, regional and health facility managers to support the roll-out of the program. MOH procured and distributed commodities required for CxCa screening and treatment of pre-cancerous lesions. To assess performance, we performed a retrospective analysis of CxCa screening and care cascade data from October 2020 through March 2022. We extracted data from the PEPFAR DATIM reporting system. We calculated the proportions of eligible WLHIV on antiretroviral therapy (ART) who were screened, those who screened positive (positivity rate), and those who received treatment for pre-cancerous lesions among those screened positive (treatment rate).
Results:
Overall, 543,639 WLHIV on ART aged 25–49 years were eligible for screening during October 2020–October 2022. By March 2022, 47% (n=255,451) of eligible WLHIV were screened, with a positivity rate of 6% (n=14,378) and treatment rate of 64% (n=9,329). Percentage of WLHIV screened increased over time, with 27% (146,033/543639) screened during October 2021-March 2022 compared to 20% (109,418/543,639) screened in a whole year period (October 2020-September 2021). Treatment rates increased over time, with 75% (5,695/7,623) treated during October 2021–March 2022 compared to 54% (3,634/6,755) during October 2020–September 2021.
Conclusions:
Improvements in proportion screened and treatment rate were due to consistent commodity distribution, enhanced technical support, and implementation of quality improvement innovations. Additional efforts are needed to ensure all WLHIV who are screened positive receive treatment, including barriers to timely referrals.