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

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


JournalBMC Public Health volume
Article typeJournal research article – Clinical research
Publication date – Aug – 2022
Authors – Serra Lem Asangbeh-Kerman, Maša Davidović, Katayoun Taghavi, James Kachingwe, Kereng Molly Rammipi, Laura Muzingwani, Magaret Pascoe, Marielle Jousse, Masangu Mulongo, Mulindi Mwanahamuntu, Neo Tapela, Oluwasanmi Akintade, Partha Basu, Xolisile Dlamini, Julia Bohlius
Keywordscervical cancer, National policies, Prevention and control, Sub-Saharan Africa, WLHIV
Open access – Yes
SpecialityObstetrics and Gynaecology, Surgical oncology
World region Central Africa, Eastern Africa, Middle Africa, Southern Africa, Western Africa

Language – English
Submitted to the One Surgery Index on August 25, 2022 at 8:52 pm
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 1st 2010 and March 31st 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.

OSI Number – 21732

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