Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies

Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention pol...

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Bibliographic Details
Published in:	BMC public health Vol. 22; no. 1; pp. 1530 - 12
Main Authors:	Asangbeh-Kerman, Serra Lem, Davidović, Maša, Taghavi, Katayoun, Kachingwe, James, Rammipi, Kereng Molly, Muzingwani, Laura, Pascoe, Magaret, Jousse, Marielle, Mulongo, Masangu, Mwanahamuntu, Mulindi, Tapela, Neo, Akintade, Oluwasanmi, Basu, Partha, Dlamini, Xolisile, Bohlius, Julia
Format:	Journal Article
Language:	English
Published:	England BioMed Central 10-08-2022 BMC
Subjects:	Acetic acid Cancer Cervical cancer Cervix Circumcision Condoms Cryotherapy Development policy Disease prevention Documents Early Detection of Cancer - methods Education Female HIV HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Human papillomavirus Humans Immunization Infections Inspection Male Medical screening Medical treatment Monitoring National policies Papillomavirus Infections - prevention & control Policies Policy Policy making Prevention Prevention and control Public health Quality control Reviews Search strategies Sex education Sexually transmitted diseases STD Sub Saharan Africa Systematic review Telemedicine Tobacco Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - prevention & control Vaccination Websites WLHIV Women Womens health Mozambique Eswatini Malawi Namibia Botswana Zimbabwe South Africa Zambia Lesotho Prevention and control WLHIV Cervical cancer Sub Saharan Africa National policies
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Summary:	Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence. We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1 2010 and March 31 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV. We reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%). Considerable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1471-2458 1471-2458
DOI:	10.1186/s12889-022-13827-0