Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey

Abstract

Introduction

Achieving cervical cancer (CC) elimination requires monitoring access to and quality of prevention and care services, particularly for women at high risk of disease, like women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) and present CC prevention and care cascades for WLHIV.

Methods

We conducted a two-level facility-based survey in 30 HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium across SSA between November 2020 and July 2021. At site-level, we performed a qualitative assessment of CC prevention and care services. At patient-level, we analysed data from routine care offered to WLHIV in SSA.

Results

HPV vaccination was uncommon across sites (33%). Referral for CC diagnosis (68%) and treatment (70%) was common and these services often came at a cost (55%) to the patient. Almost all sites had electronic health information systems (90%). However, routinely-collected data to inform indicators to monitor global targets for CC elimination in WLHIV were rare: data for monitoring were available in 36.4% of sites offering HPV vaccination, in 33.3% of sites offering cervical screening and in 20% of sites offering pre-cancer and CC treatment.

Conclusion

Although CC prevention and care services have been available in several HIV clinics across SSA for about a decade, patient and programme monitoring remain inadequate. While improving access to services, countries should consider leveraging existing health information systems, using guidance from World Health Organization tools for monitoring to improve these programmes, and track progress towards CC elimination globally.