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Review
. 2017 Feb 2:9:69-79.
doi: 10.2147/IJWH.S103868. eCollection 2017.

A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

Manuela Viviano  1 , Pierre DeBeaudrap  2 , Pierre-Marie Tebeu  3 , Jovanny T Fouogue  3 , Pierre Vassilakos  4 , Patrick Petignat  1
Affiliations
Review

A review of screening strategies for cervical cancer in human immunodeficiency virus-positive women in sub-Saharan Africa

Manuela Viviano et al. Int J Womens Health. .

Abstract

Cervical cancer (CC) is a leading cause of cancer-related death and a major public health issue in sub-Saharan Africa. This heavy burden parallels that of the human immunodeficiency virus (HIV) infection, which increases the risk of developing CC. Despite the progressive reduction of HIV prevalence in the past decade, the CC incidence and mortality rates in sub-Saharan Africa remain high. The heterogeneity of the distribution of the two diseases in the African continent, together with the different availability of human and material resources, stands in the way of finding an appropriate screening strategy. The lack of high-quality evidence on the prevention of CC for HIV-positive women, which is necessary for the implementation of efficient screening and treatment strategies, results in the absence of a clearly defined program, which is responsible for the low screening uptake and high mortality rates in sub-Saharan Africa. By taking advantage of the HIV-positive women's frequent access to health facilities, one way to increase the CC screening coverage rates would be by providing integrated HIV and screening services within the same infrastructure. With the increasing availability of cost-effective methods, screening is becoming more and more available to women who have limited access to health care. Moreover, the introduction of point-of-care technologies for human papillomavirus testing and the subsequent implementation of screen-and-treat strategies, by reducing the number of clinical appointments and, in the long term, the loss to follow-up rates, open up new opportunities for all women, regardless of their HIV status. The purpose of this review is to provide an insight into the different screening practices for CC in order to help define one that is adapted to the resources and necessities of HIV-positive women living in middle-to-low income countries.

Keywords: cervical cancer; human immunodeficiency virus (HIV); human papillomavirus (HPV); screening.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Global distribution of HIV in Africa in 2007. Note: Reproduced from Hotez PJ, Fenwick A, Kjetland EF. Africa’s 32 cents solution for HIV-AIDS. PLoS Negl Trop Dis. 2009;3(5):e430.
Figure 2
Figure 2
Cervical cancer age-standardized incidence rates per 100,000 women in 2008. Note: Reproduced with permission from Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Abbreviation: ASR, age-standardized incidence rates per 100,000 women and year.
Figure 3
Figure 3
Decision-making algorithm for VIA-based screening. Note: *If available. Abbreviations: VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol’s iodine.
Figure 4
Figure 4
Decision-making algorithm for HPV-based screening. Abbreviations: HIV, human immunodeficiency virus; HPV, human papillomavirus; VIA, visual inspection with acetic acid; VILI, visual inspection with Lugol’s iodine.
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