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

INTRODUCTION: 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. METHODS: We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1st 2010 and March 31st 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. RESULTS: 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%). CONCLUSION: 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.

The association between HIV status and antenatal care attendance among pregnant women in rural hospitals in Lesotho.

OBJECTIVE: Early and frequent antenatal clinic (ANC) attendance is important for promotion of healthy outcomes for mother and child. This study explored the relationship between HIV status at the first ANC visit and subsequent ANC attendance among pregnant women in Lesotho. METHODS: A retrospective review of ANC records from a cohort of pregnant women attending their first ANC visit in December 2009 to May 2010 in 3 rural hospitals was conducted. Wilcoxon rank sum tests compared the distribution of gestational age (GA) and ANC visit number by HIV status. RESULTS: Records from 728 women were reviewed with mean GA at the first ANC visit of 22.3 weeks (SD = 7.2) and 2.7 (SD = 1.4) mean number of ANC visits per woman. Neither number of visits nor GA at first visit differed between HIV-positive and HIV-negative women. In total, 33.9% of women completed 4 ANC visits. Women with documented HIV-positive status before ANC were more likely to present early to ANC than all other women (18.8 vs. 22.6 weeks, adjusted odds ratio = 2.54, 95% confidence interval: 1.41 to 4.57). Geographical region, increasing maternal age, and lower parity were associated with completion of expected ANC visits among all women. Increasing maternal age and CD4 count were associated with completion of expected visits among HIV-positive women. CONCLUSIONS: In Lesotho, number of subsequent visits did not differ between women testing HIV-positive and HIV-negative in ANC. However, women with documented HIV-positive status attended ANC earlier than women who were tested in ANC. HIV testing and counseling, particularly for HIV-positive women before pregnancy, can promote early ANC attendance.