Background:
Acquisition and persistence of carcinogenic human papillomavirus (HPV) infections and the incidence of precancerous lesions and invasive cervical cancers are all increased for women living with HIV (WLHIV) compared with their HIV-negative peers. To reduce new cervical cancer cases among WLHIV, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supports regular cervical cancer screening, precancerous lesion treatment, and referral for treatment of invasive cervical cancers for women accessing routine HIV services. We describe cervical cancer screening and treatment results among WLHIV in PEPFAR-supported programs.
Methods:
PEPFAR programs in 14 countries reported data semiannually at the end of March (Quarter 2) and September (Q4), 2018 to 2022. We report the absolute and relative number of WLHIV screened for cervical cancer for their first lifetime screen, routine follow up after prior negative screens, and after precancerous lesion treatment. Screen results are reported as negative, positive for precancerous lesions, and positive for suspected invasive cervical cancer. We describe the number and proportion of precancers treated with ablative and excisional therapies.
Results:
Between April 2018 and March 2022, 4.5 million cervical cancer screenings were completed; 3.7 million (82.4%) were first time screens. Screen positivity for precancerous lesions was 5.1% (229,208 positive screens), and 0.9% (40,152 women) were referred to a higher level of care for suspected cancers. A total of 169,017 precancerous lesions were treated; 19.7% (33,289) with excisional, and the remainder with ablative therapies. The proportion of ablative treatments done with cryotherapy declined by 21.0%, while the proportion using thermal ablation increased by 26.1%, when comparing 2022 to 2018 semiannual rates. The precancerous lesion treatment rate increased from 58.1% in 2018 to 83.1% in 2022.
Conclusions:
Offering cervical cancer screening services within ART clinics reached 4.5 million WLHIV at risk for cervical cancer—a significant contribution to the ongoing global effort to eliminate cervical cancer. PEPFAR programs should continue to optimize cervical cancer treatment modalities best suited to each location and to further increase the rising precancerous lesion treatment rates, to ensure that women have access to excellent cervical cancer screening and appropriate precancer treatments.
