Overview

Cervical cancer is the fourth most common cancer globally; in 2018, 570,000 women were diagnosed with and 311,000 died of cervical cancer, a vast majority in low- and middle-income countries. In sub-Saharan Africa, cervical cancer is the leading cancer cause of death, with over 110,000 cases reported in 2020. Cervical cancer is one of the most preventable and treatable cancers if managed early with adequate prevention, screening, and treatment tools. However, disparities in access and availability remain a significant barrier and contribute to 90% of the deaths due to cervical cancer in Africa. Facilitating access to routine screening and appropriate treatment services can ensure the detection of cases before they advance to more severe stages of disease and ultimately reduce the burden of cervical cancer.

Infection with a high risk or oncogenic type of Human Papillomavirus (HPV), a common sexually transmitted illness worldwide, is the primary cause of precancerous and cancerous cervical lesions. Research shows that there are more than 100 types of HPV, but two types, HPV 16 and 18, are responsible for about 70% of cervical cancer occurrences. Eight of the countries with the highest proportion of cervical cancer cases attributable to HIV, all over 40%, are in sub-Saharan Africa and also have high HIV prevalence. Women living with HIV (WLHIV) have weakened immune systems, are at higher risk of persistent HPV infection and are six times more likely to develop precancerous lesions that advance to cervical cancer, often a more severe form with increased mortality rates. Targeted approaches for WLHIV must be a priority in addressing cervical cancer risks of the most vulnerable populations.

The primary method for preventing cervical cancer is vaccinating adolescents against HPV. However, many low- and middle-income countries are yet to initiate an HPV vaccination program while many which have initiated are facing challenges in maintaining high uptake of vaccination. Thus, screening and treatment of precancerous lesions is a crucial secondary prevention method. PEPFAR’s current guidance states that screening and treatment of pre-invasive cervical cancer lesions should be integrated into routine HIV services, prioritizing WLHIV between ages 25 and 49. Preferred screening methods are quality-assured visual inspection with acetic acid (VIA) and HPV DNA testing. For women who screen positive for precancerous lesions, treatment, which removes abnormal cervical cells and prevents progression to cancer, includes cryotherapy, thermal ablation, loop electrosurgical excision procedure (LEEP), or cold knife conization depending on eligibility. Screen-negative women should rescreen within two years. WLHIV who have suspected invasive cervical cancer should be referred to the appropriate diagnostic and treatment services.

The WHO 90-70-90 targets for the global strategy to eliminate cervical cancer propose that 90% of girls be fully vaccinated with the HPV vaccine by age 15, 70% of women be screened by 35 years of age, and 90% of women identified with pre-cancer or cancer receive treatment. Although significant progress has been made in reaching these goals, in many low- and middle-income countries, cervical cancer is diagnosed at an already advanced stage. Continued scale-up and improvement of prevention, screening, and treatment measures, especially in sub-Saharan Africa, is crucial in achieving cervical cancer elimination.

USAID Impact

As an implementing agency of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), under PEPFAR’s Go Further program which was launched in 2018, USAID plays a key role increasing access to cervical cancer screening and preventive treatment for women living with HIV. USAID currently supports programs in 11 Go Further countries—Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe—as well as Nigeria.

Through this initiative, USAID programs focus on engaging communities and health systems to provide services to WLHIV at risk for cervical cancer. Examples of supported activities include:

  • Developing and utilizing innovative demand creation and community sensitization activities to promote prevention, screening, and treatment services.
  • Linking and/or referring women who screen positive for cervical cancer to treatment services.
  • Implementing point-of-care screening and treatment services.
  • Supporting capacity building of health workforce and structural support to health facilities.
  • Providing technical guidance on best screening and treatment practices.
  • Monitoring and evaluating programs regularly to ensure implementation of quality service delivery, understand best practices and address challenges.
  • Implementing quality improvement and quality assurance initiatives to improve screening, treatment and monitoring of adverse events.
  • Collaborating with host country governments and partners to establish accurate and current guidelines.

2021 Achievements

In Fiscal Year 2021, USAID programs:

  • Continued to scale up cervical cancer screening, with a total of 631,140 WLHIV screened:
    • First-time screening for 519,483 WLHIV
    • Follow-up screening for 20,077 WLHIV
    • Rescreened 91,580 WLHIV
  • Treated 76.2% of those with a positive cervical screening (20,098 treated of 26,386 positive)
  • Supported 1,120 facilities in providing cervical cancer services
  • Provided targeted training for the health workforce on screening and treatment strategies
  • Collaborated with Family Planning and Key Population programs to reach more WLHIV

Additional Resources