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Review
. 2024 Feb 1;95(2):170-178.
doi: 10.1097/QAI.0000000000003343.

Facility-Based Indicators to Manage and Scale Up Cervical Cancer Prevention and Care Services for Women Living With HIV in Sub-Saharan Africa: a Three-Round Online Delphi Consensus Method

Maša Davidović  1   2   3 , Serra Lem Asangbeh  2   3   4 , Katayoun Taghavi  5 , Tafadzwa Dhokotera  2   3   4 , Antoine Jaquet  6 , Beverly Musick  7 , Cari Van Schalkwyk  8 , David Schwappach  5 , Eliane Rohner  5 , Gad Murenzi  9 , Kara Wools-Kaloustian  10 , Kathryn Anastos  11 , Orang'o Elkanah Omenge  12 , Simon Pierre Boni  13   14 , Stephany N Duda  15 , Per von Groote  5 , Julia Bohlius  2   3   5 ; International Epidemiology Databases to Evaluate AIDS
Affiliations
Review

Facility-Based Indicators to Manage and Scale Up Cervical Cancer Prevention and Care Services for Women Living With HIV in Sub-Saharan Africa: a Three-Round Online Delphi Consensus Method

Maša Davidović et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics.

Methods: We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3).

Results: We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2).

Conclusion: We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade.

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Conflict of interest statement

S.L.A. received the Swiss Government Excellence Scholarship, No 2019.0741. The remaining authors have no funding or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
The Cervical Cancer Control Continuum at Facility Level: the overview of domains, core, optional and 1st ranked indicators per each domain that reached consensus in Round 3. Consensus is reached if the indicator had a high level of agreement (more than 70% of respondents rated an indicator as 4 and 5 points on Likert scale) in three or more criteria. Within each domain, the core and optional indicators are ordered based on their rating results, with the highest-rated indicator placed at the top. Core indicators are indicators that reached a high level of agreement in all five criteria, and optional indicators are those with a high level of agreement in three or four criteria. The indicator ranked as the most important in each domain is presented as 1st ranked indicator
Figure 2.
Figure 2.
Representative countries in the Expert Panel in all three Delphi rounds (total participants, n=65).
Figure 3.
Figure 3.
List of indicators that reached consensus in Round 3. Consensus was reached if more than 70% of participants rated the indicator as 4 (High) or 5 (Very high) points on the Likert scale in 3 or more criteria
See this image and copyright information in PMC

References

    1. Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021;9(2):e161–e169. - PMC - PubMed
    1. Liu G, Sharma M, Tan N, et al. HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer. AIDS. 2018;32(6):795–808. - PMC - PubMed
    1. Ibrahim Khalil A, Mpunga T, Wei F, et al. Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa. Int J Cancer. 2022;150(5):761–772. - PMC - PubMed
    1. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: World Health Organization; 2020.
    1. Rao DW, Bayer CJ, Liu G, et al. Modelling cervical cancer elimination using single-visit screening and treatment strategies in the context of high HIV prevalence: estimates for KwaZulu-Natal, South Africa. Journal of the International AIDS Society. 2022;25(10):e26021. - PMC - PubMed

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