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Cited by 42Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

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Viviano, Manuela, DeBeaudrap, Pierre, Tebeu, Pierre-Marie, Tsuala Fouogue, Jovanny, Vassilakos, Pierre, Petignat, Patrick·2017·International Journal of Women's Health
DOI 10.2147/ijwh.s103868PMC PMC5298303
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Abstract

Cervical cancer (CC) is a leading cause of cancer-related death and a major public health issue in sub-Saharan Africa. This heavy burden parallels that of the human immunodeficiency virus (HIV) infection, which increases the risk of developing CC. Despite the progressive reduction of HIV prevalence in the past decade, the CC incidence and mortality rates in sub-Saharan Africa remain high. The heterogeneity of the distribution of the two diseases in the African continent, together with the different availability of human and material resources, stands in the way of finding an appropriate screening strategy. The lack of high-quality evidence on the prevention of CC for HIV-positive women, which is necessary for the implementation of efficient screening and treatment strategies, results in the absence of a clearly defined program, which is responsible for the low screening uptake and high mortality rates in sub-Saharan Africa. By taking advantage of the HIV-positive women's frequent access to health facilities, one way to increase the CC screening coverage rates would be by providing integrated HIV and screening services within the same infrastructure. With the increasing availability of cost-effective methods, screening is becoming more and more available to women who have limited access to health care. Moreover, the introduction of point-of-care technologies for human papillomavirus testing and the subsequent implementation of screen-and-treat strategies, by reducing the number of clinical appointments and, in the long term, the loss to follow-up rates, open up new opportunities for all women, regardless of their HIV status. The purpose of this review is to provide an insight into the different screening practices for CC in order to help define one that is adapted to the resources and necessities of HIV-positive women living in middle-to-low income countries.

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  • The increased sensitivity of HPV testing for cervical precancerous lesions is due to earlier detection rather than overdiagnosis.

    “The increased sensitivity of HPV testing for cervical precancerous lesions has been shown to be due to earlier detection rather than overdiagnosis [22–25].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [25]

    The HPV testing section states that HPV testing is more sensitive than cytology for identifying cervical precancerous lesions, though less specific (page not available in our copy). It does not say that the greater sensitivity results from earlier detection rather than overdiagnosis. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • HPV testing has practical advantages such as limited training requirements and the potential for self-sampling that ease the burden on healthcare resources, making it suitable for resource-limited settings.

    “Furthermore, practical advantages such as limited training requirements and the potential for self-sampling ease the burden on healthcare resources, making it suitable for resource-limited settings [22, 24–26].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [25]

    The HPV testing section says self-sampling could improve screening coverage in low- and middle-income countries where infrastructure and health personnel are limited. It also describes point-of-care HPV tests that require limited infrastructure. The passages do not establish that HPV testing requires limited training, so that part of the attributed claim is unsupported. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Pap smear missed a substantial proportion of HSIL+ lesions.

    “Although Pap smear showed the highest specificity (94.5%), it missed a substantial proportion of HSIL+ lesions, emphasizing the clinical advantage of HPV testing in this population [21, 22, 24, 25, 27].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [25]

    The Overview of current screening strategies reports a high rate of false-negative Pap tests for cervical precancerous lesions in HIV-positive women. The HPV testing section also says HPV testing is more sensitive than cytology. These passages support the point that Pap smears miss lesions, but they do not establish the missed proportion specifically for HSIL+ lesions. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In a cohort of 1128 WLHIV, HPV testing achieved a sensitivity of 94.5% for detecting LSIL or worse, outperforming VIA (83.6%) and Pap smear (63.3%).

    “In a cohort of 1128 WLHIV, HPV testing achieved a sensitivity of 94.5% for detecting LSIL or worse, outperforming VIA (83.6%) and Pap smear (63.3%).”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [25]

    The HPV testing section states that HPV testing is more sensitive than cytology for cervical precancerous lesions, and it describes an advantage over VIA in a screen-and-treat trial. Our copy does not substantiate a cohort of 1,128 women, an LSIL-or-worse endpoint, or the three stated sensitivity percentages (searched: 1128, 94.5%, LSIL, and Table 2). (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Pap smear showed the highest specificity (94.5%) in that cohort.

    “Although Pap smear showed the highest specificity (94.5%), it missed a substantial proportion of HSIL+ lesions, emphasizing the clinical advantage of HPV testing in this population [21, 22, 24, 25, 27].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [25]

    The HPV testing section (page unavailable) says HPV testing is more sensitive than cytology but has lower specificity, supporting the comparison with Pap testing. The review does not report a Pap-smear specificity of 94.5% or identify the cohort to which that figure refers (searched: 94.5, Pap-smear specificity, and cytology). (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Viviano, M., DeBeaudrap, P., Tebeu, P.-M., Tsuala Fouogue, J., Vassilakos, P., & Petignat, P.
Affiliations
  • University Hospital of Geneva (CH)
  • University Teaching Hospital of Yaounde (CM)
Corresponding author
Viviano, Manuela
ORCID
Venue
International Journal of Women's Health
Publisher
Informa UK Limited
Published
2017-02
Volume
Volume 9
Pages
69-79
ISSN
1179-1411 (ISSN-L)
DOI
10.2147/ijwh.s103868
PMC
PMC5298303
OpenAlex
W2585406125
Cited by
42
References
2
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 3 · 2018: 6 · 2017: 1
FWCI
0.47
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Women s Health (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
  • HAL (acceptedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc)
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, women living with HIV, sub-Saharan Africa, HPV testing, point-of-care testing, screen-and-treat, cervical cancer prevention, screening uptake, resource-limited settings

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