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,(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.
iterative process, participants adapted the indicators to their context
