Cervical Cancer Screening Cascade for women living with HIV: A cohort study from Zimbabwe

作者：Katayoun Taghavi, Ardele Mandiriri, Tinei Shamu, Eliane Rohner, Lukas Bütikofer, Serra Lem Asangbeh, Tsitsi Magure, Cleophas Chimbetete, Matthias Egger, Margaret Pascoe, Julia Bohlius · 发表于：PLOS Global Public Health · 年份：2022 · DOI：10.1371/journal.pgph.0000156 · 被引用次数：26 · 研究领域：Cervical Cancer and HPV Research、Global Cancer Incidence and Screening、Hepatitis B Virus Studies

Countries with high HIV prevalence, predominantly in sub-Sahahran Africa, have the highest cervical cancer rates globally. HIV care cascades successfully facilitated the scale-up of antiretroviral therapy. A cascade approach could similarly succeed to scale-up cervical cancer screening, supporting WHO's goal to eliminate cervical cancer. We defined a Cervical Cancer Screening Cascade for women living with HIV (WLHIV), evaluating the continuum of cervical cancer screening integrated into an HIV clinic in Zimbabwe. We included WLHIV aged ≥18 years enrolled at Newlands Clinic in Harare from June 2012-2017 and followed them until June 2018. We used a cascade approach to evaluate the full continuum of secondary prevention from screening to treatment of pre-cancer and follow-up. We report percentages, median time to reach cascade stages, and cumulative incidence at two years with 95% confidence intervals (CI). We used univariable Cox proportional hazard regressions to calculate cause-specific hazard ratios with 95% CIs for factors associated with completing the cascade stages. We included 1624 WLHIV in the study. The cumulative incidence of cervical screening was 85.4% (95% CI 83.5-87.1) at two years. Among the 396 WLHIV who received screen-positive tests in the study, the cumulative incidence of treatment after a positive screening test was 79.5% (95% CI 75.1-83.2) at two years. The cumulative incidence of testing negative at re-screening after treatment was 36.1% (95% CI 31.2-40....