Enhanced cervical cancer and HIV interventions reduce the disproportionate burden of cervical cancer cases among women living with HIV: A modeling analysis.

Autor: Broshkevitch CJ; Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America., Barnabas RV; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America.; Harvard Medical School, Boston, MA, United States of America., Liu G; Department of Global Health, University of Washington, Seattle, WA, United States of America., Palanee-Phillips T; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America., Rao DW; Department of Global Health, University of Washington, Seattle, WA, United States of America.; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 May 23; Vol. 19 (5), pp. e0301997. Date of Electronic Publication: 2024 May 23 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0301997
Abstrakt: Introduction: Women living with HIV experience heightened risk of cervical cancer, and over 50% of cases in Southern Africa are attributed to HIV co-infection. Cervical cancer interventions tailored by HIV status delivered with HIV antiretroviral therapy (ART) for treatment can decrease cancer incidence, but impact on HIV-related disparities remains understudied.
Methods: Using a dynamic model calibrated to KwaZulu-Natal, South Africa, we projected HIV prevalence, cervical cancer incidence, and proportion of cancer cases among women living with HIV between 2021-2071. Relative to the status quo of moderate intervention coverage, we modeled three additive scenarios: 1) ART scale-up only; 2) expanded human papillomavirus (HPV) vaccination, screening, and treatment; and 3) catch-up HPV vaccination and enhanced screening for women living with HIV.
Results: Under the status quo, HIV prevalence among women aged 15+ decreased from a median of 35% [Uncertainty Range (UR): 26-42%] in 2021 to 25% [19-34%] in 2071. The proportion of cervical cancer cases that were women living with HIV declined from 73% [63-86%] to 58% [47-74%], but incidence remained 4.3-fold [3.3-5.7] that of women without HIV. ART scale-up reduced HIV prevalence in 2071, but increased the incidence rate ratio to 5.2 [3.7-7.3]. Disparities remained after expanding cancer interventions for all women (incidence rate ratio: 4.8 [3.6-7.6]), while additional catch-up HPV vaccination and screening for women living with HIV decreased the incidence rate ratio to 2.7 [1.9-3.4] in 2071.
Conclusions: Tailored cervical cancer interventions for women living with HIV can counteract rising cancer incidence incurred by extended life expectancy on ART and reduce disparate cancer burden.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Outside of the submitted work, CJB acknowledges part-time employment by Merck & Co., Inc for a graduate research assistantship. GL also acknowledges employment with Merck & Co., Inc, unrelated to the submitted work. RVB declares support from the US National Institutes of Health, the Bill and Melinda Gates Foundation, and the World Health Organization. Regeneron Pharmaceuticals covered the cost of abstract and manuscript writing outside the submitted work. RVB serves on a Gilead Sciences DMC for which she receives an honorarium. TPP acknowledges support from the US National Institutes of Health, National Institute of Mental Health, US Agency for International Development, GSI, and MSD unrelated to the submitted work. TPP also participates in the South Africa PrEP Technical working group, Dual Prevention Pill Advisory committee, and MOSAIC Product Access Advisory committee outside the submitted work. DWR declares support from the US National Institutes of Health, US Agency for International Development, and World Health Organization unrelated to the submitted work, as well as employment by the Bill & Melinda Gates Foundation after all analyses were conducted.
(Copyright: © 2024 Broshkevitch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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