Cervical Cancer Screening Positivity Among Women Living With HIV in CDC-PEPFAR Programs 2018-2022

Abstract

Background: The US President's Emergency Plan for AIDS Relief aims to address the higher risk of cervical cancer among women living with HIV by offering high-quality screening services in the highest burden regions of the world.

Methods: We analyzed the US President's Emergency Plan for AIDS Relief Monitoring, Evaluation, and Reporting data from Centers for Disease Control and Prevention-supported sites in 13 countries in sub-Saharan Africa for women living with HIV aged older than 15 years who accessed cervical cancer screening services (mostly visual inspection, with ablative or excisional treatment offered for precancerous lesions), April 2018-March 2022. We calculated the positivity by age, country, and clinical visit type (first lifetime screen or routine rescreening). We fitted negative binomial random coefficient models of log-linear trends in time to estimate the probabilities of testing positive and any temporal trends in positivity.

Results: Among the 2.8 million completed cancer screens, 5.4% identified precancerous lesions, and 0.8% were positive for suspected invasive cervical cancers (6.1% overall). The positivity rates declined over the study period among those women screening for cervical cancer for the first time and among those women presenting to antiretroviral therapy clinics for routine rescreening.

Conclusions: These positivity rates are lower than expectations set by the published literature. Further research is needed to determine whether these lower rates are attributable to the high level of consistent antiretroviral therapy use among these populations, and systematic program monitoring and quality assurance activities are essential to ensure women living with HIV have access to the highest possible quality prevention services.

FIGURE 1.

Proportions¹ of positive screening tests² among women living with HIV in CDC-PEPFAR–supported cervical cancer prevention programs by visit type, April 2018–March 2022. ¹Vertical bars are pointwise uncertainty intervals containing the true value with 0.95 probability. ²Positive cervical cancer tests include positive for precancerous lesions and for suspected invasive cervical cancers.

FIGURE 2.

Risk ratios¹ for annual trends in screening test positivity² for each additional year among women living with HIV in CDC-PEPFAR–supported cervical cancer prevention programs, April 2018–March 2022. Note the expanded scale for trend risk ratios in C. ¹Risk ratios of 1.0 imply constant proportions over time, and negative ratios imply exponential declines in positive screens. Horizontal bars are uncertainty intervals containing the true risk ratios with 0.95 probability. ²Positive cervical cancer tests include positive for precancerous lesions and for suspected invasive cervical cancers.