Cost-Effective Cervical Cancer Screening Strategies for Women with HIV in KwaZulu-Natal

Evaluating Cost-Effective Cervical Cancer Screening in High HIV-Prevalence Settings

In this review we summarize the results of a study on the cost-effectiveness of single-visit cervical cancer screening strategy in KwaZulu-Natal, South Africa. The region faces high HIV prevalence, increasing the risk of cervical cancer. A dynamic transmission model was used to compare HPV DNA testing, genotyping, and automated visual evaluation (AVE) against the current multi-visit approach. Findings show that repeat single-visit screening with HPV DNA testing is the most effective and cost-efficient strategy, especially for women living with HIV (WLHIV). This approach aligns with WHO recommendations.

Key Findings on Cervical Cancer Screening

KwaZulu-Natal has a significant burden of HIV and HPV. Women with HIV face a higher risk of developing cervical cancer due to weakened immune systems.

Repeat single-visit cervical cancer screening with HPV DNA testing reduces cervical cancer cases and deaths. This method provides a practical and effective alternative to multi-visit strategies.

The study finds that repeat HPV DNA testing has an incremental cost-effectiveness ratio (ICER) below South Africa’s GDP per capita threshold. This makes it a financially viable option for national programs.

Expanding HPV vaccination coverage to 90% could significantly lower cervical cancer cases and deaths. However, the high cost of the nonavalent HPV vaccine remains a challenge.

Automated visual evaluation (AVE) shows promise for future HPV screening. However, uncertainties about cost and performance require further study before widespread adoption.

Challenges such as inadequate infrastructure, insufficient trained personnel, and loss to follow-up hinder effective cervical cancer screening in resource-limited settings.

Context and Policy Considerations

The WHO aims to eliminate cervical cancer by 2030 with its 90-70-90 targets. These include vaccinating 90% of girls, screening 70% of women with high-performance tests, and ensuring 90% of women with pre-cancerous lesions receive treatment.

Women living with HIV are more susceptible to HPV and its progression to cervical cancer. Their compromised immune status accelerates disease development, highlighting the need for targeted screening strategies.

Many low- and middle-income countries (LMICs) struggle to expand HPV screening. Limited infrastructure, equipment, and trained professionals remain major obstacles.

Studies confirm the cost-effectiveness of single-visit cervical cancer screening and HPV DNA testing. Findings emphasize the need for repeat screening and integrating emerging technologies like AVE.

Implications for Health Policy and Research

Implementing cost-effective screening strategies in LMICs can improve health outcomes at manageable costs. HPV DNA testing in single-visit models aligns with WHO recommendations and enhances healthcare efficiency.

For WLHIV, screening every five years minimizes cervical cancer risk. For HIV-negative women, screening at ages 35–39 and 45–49 offers effective protection.

Policymakers must invest in HPV DNA testing and vaccination programs. Scaling up these efforts in high HIV prevalence areas will significantly reduce cervical cancer incidence and mortality.

Future Research Directions

Further studies should explore AVE’s cost-effectiveness and integration into existing cervical cancer screening programs. Addressing uncertainties in performance and affordability will support better decision-making.

This study highlights critical insights for health economics and outcomes research. Investing in single-visit cervical cancer screening strategies will improve access to care and long-term public health outcomes.