The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study

• Type of Material: Article
• Authors: Pablo Noel Perez-Guzman, Imperial College London; Michael Chung, Emory University; Hugo De Vuyst, International Agency for Research on Cancer; Shona Dalal, World Health Organization; Kennedy K. Mutai, National AIDS Control Council; Karanja Muthoni, National AIDS & STI Control Programme; Bartilol Kigen, National AIDS & STI Control Programme; Nduku Kilonzo, National AIDS Control Council; Timothy B. Hallett, Imperial College London; Mikaela Smit, Imperial College London
• Language: English
• Date: 2020-03-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2020.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjgh-2019-001886
• Title of Journal or Parent Work: BMJ GLOBAL HEALTH
• Volume: 5
• Issue: 3
• Start Page: e001886
• End Page: e001886
• Grant/Funding Information: This study was funded by CDRF Global, MRC Centre for Global Infectious Diseases Analysis, and Foundation for the National Institutes of Health.
• Keywords: CRYOTHERAPY; POSITIVE WOMEN; DISEASE; Life Sciences & Biomedicine; COST-EFFECTIVENESS; Public, Environmental & Occupational Health; PROGRAM; RISK; COUNTRIES; Science & Technology; VISUAL INSPECTION; STRATEGIES; KNOWLEDGE
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Oncology; Biology, Virology

Abstract

Introduction We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18-65 in Kenya. Methods Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, and engaged in care (numbers screened, treated and cured) and five yearly age-standardised incidence. Results All options will reduce CC cases and deaths compared with no scale-up. Options 1-3 will perform similarly, averting approximately 28 000 (33%) CC cases and 7700 (27%) deaths. That is, VIA screening would yield minimal losses to follow-up (LTFU). Conversely, LTFU associated with HPV-DNA testing will yield a lower care engagement, despite better diagnostic performance. In contrast, option 4 would maximise health outcomes, averting 43 200 (50%) CC cases and 11 800 (40%) deaths, given greater care engagement. Yearly rescreening with either option will impose a substantial burden on the health system, which could be reduced by spacing out frequency to three yearly without undermining health gains. Conclusions Beyond the specific choice of technologies to scale up, efficiently using available options will drive programmatic success. Addressing practical constraints around diagnostics' performance and LTFU will be key to effectively avert CC cases and deaths.