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Cited by 31Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGenital Health and Disease

Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies

Open access
Asangbeh-Kerman, Serra Lem, Davidović, Maša, Taghavi, Katayoun, Kachingwe, James, Rammipi, Kereng Molly, Muzingwani, Laura, Pascoe, Magaret, Jousse, Marielle +7 more·2022·BMC Public Health
DOI 10.1186/s12889-022-13827-0PMC PMC9367081
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Abstract

Introduction: Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence. Methods: We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1 st 2010 and March 31 st 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV. Results: We reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%). Conclusion: Considerable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities.

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  • Integration with ART services has led to successful sustenance and expansion of cervical screening programmes (often VIA-based) in several sub-Saharan African countries.

    “Integration with ART services has seen successful sustenance and expansion of cervical screening programmes (often VIA-based) in several sub-Saharan African countries, demonstrating the potential of this model [10, 36].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [36]

    The Results section on screening and treatment (page not provided) reports that cervical screening was integrated into HIV clinics in five countries and that VIA was a commonly recommended test. It does not establish that integration specifically with ART services caused programmes to be sustained or expanded successfully. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Policy recommendations for HPV DNA testing exist in some African nations, but widespread implementation is still pending.

    “While policy recommendations for HPV DNA testing exist in some African nations, widespread implementation is still pending [10, 36].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [36]

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Authors
Asangbeh-Kerman, S. L., Davidović, M., Taghavi, K., Kachingwe, J., Rammipi, K. M., Muzingwani, L., Pascoe, M., Jousse, M., Mulongo, M., Mwanahamuntu, M., Tapela, N., Akintade, O., Basu, P., Dlamini, X., & Bohlius, J.
Affiliations
  • University of Bern (CH)
  • Ministry of Health (MW)
  • Ministry of Health (BW)
  • SolidarMed (CH)
  • University of the Witwatersrand (ZA)
  • Brigham and Women's Hospital (US)
  • Elizabeth Glaser Pediatric AIDS Foundation (US)
  • Centre international de recherche sur le cancer (FR)
  • Ministry of Health (SZ)
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2022-08-10
Volume
22
Issue
1
Pages
1530-1530
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-022-13827-0
PMC
PMC9367081
OpenAlex
W4291020294
Cited by
31
References
2
Citations by year
2026: 11 · 2025: 7 · 2024: 10 · 2023: 3
FWCI
0.79
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • edoc (University of Basel) (acceptedVersion)
  • BORIS (University Library Bern) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Open Access CRIS of the University of Bern
Funders
  • National Science Foundation
  • World Health Organization
  • European Commission (801076, HORIZON2020, 2019-2021)
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (177319)
  • National Institute of Allergy and Infectious Diseases (U01AI069924)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Surgery › Genital Health and Disease
Keywords
cervical cancer prevention, women living with HIV, cancer control policy, HPV vaccination, cervical cancer screening, visual inspection with acetic acid, Pap smear, cervical precancerous lesions, cryotherapy, loop electrosurgical excision procedure, tobacco control, condom use, sex education, male circumcision, cancer care costs, sub-Saharan Africa
MeSH terms
Uterine Cervical Neoplasms, Female, Humans, Male, HIV Infections, Papillomavirus Infections, Early Detection of Cancer, Policy

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