The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study
Introduction We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.Methods Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/3/e001886.full |
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| author | Timothy B Hallett Hugo de Vuyst Pablo Noel Perez-Guzman Michael Hoonbae Chung Shona Dalal Kennedy K Mutai Karanja Muthoni Bartilol Kigen Nduku Kilonzo Mikaela Smit |
| author_facet | Timothy B Hallett Hugo de Vuyst Pablo Noel Perez-Guzman Michael Hoonbae Chung Shona Dalal Kennedy K Mutai Karanja Muthoni Bartilol Kigen Nduku Kilonzo Mikaela Smit |
| author_sort | Timothy B Hallett |
| collection | DOAJ |
| description | Introduction We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.Methods Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, and engaged in care (numbers screened, treated and cured) and five yearly age-standardised incidence.Results All options will reduce CC cases and deaths compared with no scale-up. Options 1–3 will perform similarly, averting approximately 28 000 (33%) CC cases and 7700 (27%) deaths. That is, VIA screening would yield minimal losses to follow-up (LTFU). Conversely, LTFU associated with HPV-DNA testing will yield a lower care engagement, despite better diagnostic performance. In contrast, option 4 would maximise health outcomes, averting 43 200 (50%) CC cases and 11 800 (40%) deaths, given greater care engagement. Yearly rescreening with either option will impose a substantial burden on the health system, which could be reduced by spacing out frequency to three yearly without undermining health gains.Conclusions Beyond the specific choice of technologies to scale up, efficiently using available options will drive programmatic success. Addressing practical constraints around diagnostics’ performance and LTFU will be key to effectively avert CC cases and deaths. |
| format | Article |
| id | doaj-art-7ad0d07a8d914efeb37320984cc67c68 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-7ad0d07a8d914efeb37320984cc67c682025-08-20T01:53:33ZengBMJ Publishing GroupBMJ Global Health2059-79082020-03-015310.1136/bmjgh-2019-001886The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling studyTimothy B Hallett0Hugo de Vuyst1Pablo Noel Perez-Guzman2Michael Hoonbae Chung3Shona Dalal4Kennedy K Mutai5Karanja Muthoni6Bartilol Kigen7Nduku Kilonzo8Mikaela Smit9Department of Infectious Disease Epidemiology, Imperial College London, London, UKInfections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, FranceDepartment of Infectious Disease Epidemiology, Imperial College London, London, UKDepartment of Medicine, Aga Khan University, Nairobi, KenyaDepartment of HIV/AIDS, World Health Organization, Geneva, SwitzerlandNational AIDS Control Council, Nairobi, KenyaNational AIDS and STI Control Programme, Nairobi, KenyaNational AIDS and STI Control Programme, Nairobi, KenyaNational AIDS Control Council, Nairobi, KenyaDepartment of Infectious Disease Epidemiology, Imperial College London, London, UKIntroduction We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.Methods Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, and engaged in care (numbers screened, treated and cured) and five yearly age-standardised incidence.Results All options will reduce CC cases and deaths compared with no scale-up. Options 1–3 will perform similarly, averting approximately 28 000 (33%) CC cases and 7700 (27%) deaths. That is, VIA screening would yield minimal losses to follow-up (LTFU). Conversely, LTFU associated with HPV-DNA testing will yield a lower care engagement, despite better diagnostic performance. In contrast, option 4 would maximise health outcomes, averting 43 200 (50%) CC cases and 11 800 (40%) deaths, given greater care engagement. Yearly rescreening with either option will impose a substantial burden on the health system, which could be reduced by spacing out frequency to three yearly without undermining health gains.Conclusions Beyond the specific choice of technologies to scale up, efficiently using available options will drive programmatic success. Addressing practical constraints around diagnostics’ performance and LTFU will be key to effectively avert CC cases and deaths.https://gh.bmj.com/content/5/3/e001886.full |
| spellingShingle | Timothy B Hallett Hugo de Vuyst Pablo Noel Perez-Guzman Michael Hoonbae Chung Shona Dalal Kennedy K Mutai Karanja Muthoni Bartilol Kigen Nduku Kilonzo Mikaela Smit The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study BMJ Global Health |
| title | The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study |
| title_full | The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study |
| title_fullStr | The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study |
| title_full_unstemmed | The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study |
| title_short | The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study |
| title_sort | impact of scaling up cervical cancer screening and treatment services among women living with hiv in kenya a modelling study |
| url | https://gh.bmj.com/content/5/3/e001886.full |
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