Interventions and Strategies to Increase Cervical Cancer Screening, Treatment, and Retention in Care among Persons with HIV in Low- and Middle-Income Countries: A Systematic Review

Abstract

Cervical cancer (CC) and HIV pose two major public health challenges, with low and middle-income countries (LMICs) exhibiting the highest disease burden and mortality rate for both HIV and CC-related deaths worldwide. Populations with HIV in LMICs are six times more likely to develop CC compared to the general population. Further, CC is the most frequently detected cancer and leading cause of death among women with HIV (WWH). This systematic review synthesized the literature and identified key elements of interventions to increase CC awareness, screening, treatment, and retention in care among persons with HIV in LMICs. Four databases were searched for peer reviewed articles in the last 10 years that described and assessed the effectiveness of these interventions, and 10 articles were identified and reviewed. Interventions that included community/spiritual leaders, trained non-physician medical providers, used pre-existing facilities (e.g. HIV, family planning, reproductive health), integrated "screen and treat" approaches, and used visual inspection methods (VIA/VILI; excluding Pap smears) were associated with higher rates of CC awareness, screening, engagement in subsequent treatment, and overall retention in care. Most studies focused on increasing awareness, screening, and engagement in care, demonstrating the need for interventions that are also designed to increase retention in the CC continuum of care among WWH. Additionally, few interventions had long follow-up periods, which should be included to effectively track sustained retention in care.

Keywords: Cervical cancer; Cervical cancer screening; Cervical cancer treatment; HIV; Low- and middle- income countries; Retention.