An Insight into Cervical Cancer Screening and Treatment Capacity in Sub-Saharan Africa

Abstract

OBJECTIVE— Approximately 85% of cervical cancer cases and deaths occur in resource- constrained countries where best practices for prevention, particularly for HIV-infected women, still need to be developed. The objective of this study was to assess cervical cancer prevention capacity in select HIV clinics located in resource-constrained countries. METHODS— A cross-sectional survey of sub-Saharan African sites of four NIH-funded HIV/ AIDS networks was conducted. Sites were surveyed on the availability of cervical cancer screening and treatment among HIV-infected and HIV-uninfected women. Descriptive statistics, and chi-square or Fisher’s exact test were used as appropriate. RESULTS— Fifty-one out of 78 (65%) sites responded. Access to cervical cancer screening was reported by 49 (96%) sites. Of these sites, 39 (80%) performed screening on-site. Central African sites were less likely to have screening on-site (P= 0.02) versus other areas. Visual inspection with acetic acid (VIA) and Pap testing were the most commonly available on-site screening methods at 31 (79%) and 26 (67%) sites, respectively. High-risk HPV testing was available at 29% of sites with VIA and 50% of sites with Pap testing. Cryotherapy and radical hysterectomy were the most commonly available on-site treatment methods for premalignant and malignant lesions at 29 (74%) and 18 (46%) sites, respectively. CONCLUSION— Despite limited resources, the majority of sites surveyed had the capacity to perform cervical cancer screening and treatment. The existing infrastructure of HIV clinical and research sites may provide the ideal framework for scale up of cervical cancer prevention in resource-constrained countries with a high burden of cervical dysplasia