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Cited by 20Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Cervical cancer screening and treatment, HIV infection, and age: Program implementation in seven regions of Namibia

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Korn, Abigail K., Muzingwani, Laura, O’Bryan, Gillian, Ensminger, Alison, Boylan, Ashley D., Kafidi, Eva-Liisa, Kashali, Matheus, Ashipala, Laimi +5 more·2022·PLOS ONE
DOI 10.1371/journal.pone.0263920PMC PMC8849510
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Abstract

The aim of this study was to assess differences in cervical cancer screening and treatment outcomes by HIV status in a routine programmatic setting with a high generalized HIV prevalence. Women living with HIV (WLHIV) are at heightened risk of developing cervical cancer and the World Health Organization recommends all WLHIV who are sexually active be screened, regardless of age. In 2018, Namibia’s Ministry of Health and Social Services introduced a screen-and-treat approach using visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy or thermocoagulation with a focus on screening HIV-positive women due to Namibia’s 11.5% prevalence of HIV in women aged 15–49. Using program data from October 2018 to March 2020 from seven of the country’s 14 regions, we calculated descriptive statistics and chi-square tests to test the statistical significance of differences in VIA-positivity, ineligibility for ablative treatment, treatment completion, and same day treatment completion by HIV status. Between October 2018 and March 2020, the program conducted 14,786 cervical cancer screenings. Among 8,150 women who received their first VIA screening, more WLHIV screened VIA-positive (17%) than HIV-negative women (15%). This difference was statistically significant (p = 0.02). Among 2,272 women who screened VIA-positive at any screening, 1,159 (82%) completed ablative treatment. This suggests ablative treatment is feasible and acceptable in resource-limited settings. WLHIV were also more likely to complete treatment than HIV-negative women (p<0.01). Differences in health seeking behavior of sub-populations as well as resource availability between service delivery points should be considered for further investigation. Going forward in order to strengthen program implementation and expand screening access and uptake further investigation is needed to determine cancer incidence by HIV status, age, and time since last screening to assess cases that are averted as well as potential rates of overtreatment.

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  • Women living with HIV face a six-to-tenfold increased risk of cervical cancer compared to HIV-negative women.

    “Women living with HIV (WLHIV) face an almost six-to-ten-fold increased risk of cervical cancer compared to HIV-negative women [8–10].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [10]

    The Introduction says women living with HIV have heightened cervical cancer risk, citing data showing up to a six-fold increase in incidence compared with HIV-negative women. It does not support the claimed upper end of ten-fold. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [10]

    The Conclusions (page not provided) report that a VIA screening programme delivered through routine HIV services in Namibia provided 14,786 screenings in its first 18 months and continues to expand. This supports the model’s potential, but the paper does not establish sustained expansion in several sub-Saharan African countries or specifically attribute that expansion to integration with ART services. (LLM, conf=0.86)

    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 [10]

    The Introduction (page not available) says HPV DNA testing was not yet available in Namibian public health facilities, and the Conclusions say widespread HPV testing was not yet feasible. But the paper describes Namibia’s screening policy as relying on VIA; it does not establish that some African nations have policy recommendations for HPV DNA testing. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • India's National AIDS Control Programme includes a network of over 2500 ART centres providing regular care to over a million people living with HIV.

    “which includes a network of over 2500 ART centres (including ART centres, link ART centres, and care support centres) providing regular care to over a million people living with HIV across the country [8, 10, 13].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [10]

    The Introduction and Conclusions discuss cervical cancer screening integrated with HIV services in Namibia, not India's National AIDS Control Programme. Searches for India, 2,500 ART centres, and the number of people receiving care found no passage addressing the cited figures. (LLM, conf=0.77)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 24

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Authors
Korn, A. K., Muzingwani, L., O’Bryan, G., Ensminger, A., Boylan, A. D., Kafidi, E.-L., Kashali, M., Ashipala, L., Nitschke, A.-M., Dziuban, E. J., Forster, N., Eckert, L. O., & O’Malley, G.
Affiliations
  • University of Washington (US)
  • Centers for Disease Control and Prevention (US)
  • Ministry of Health and Social Services (NA)
Corresponding author
Korn, Abigail K.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2022-02-16
Volume
17
Issue
2
Pages
e0263920
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0263920
PMC
PMC8849510
OpenAlex
W4213154228
Cited by
20
References
0
Citations by year
2026: 1 · 2025: 10 · 2024: 3 · 2023: 6
FWCI
3.43
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Centers for Disease Control and Prevention (GH001430)
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
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
cervical cancer screening, HIV infection, visual inspection with acetic acid, ablative treatment, cryotherapy, thermocoagulation, screen-and-treat, women living with HIV, treatment completion, age differences, program implementation, Namibia, resource-limited settings
MeSH terms
Adolescent, Adult, Uterine Cervical Neoplasms, Cross-Sectional Studies, Delivery of Health Care, Electrocoagulation, Female, Health Plan Implementation, HIV, Humans, Middle Aged, Namibia, HIV Infections, Incidence, Cryotherapy, Early Detection of Cancer, Young Adult

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