Cervical cancer care cascade among women living with human immunodeficiency virus in 13 sub-Saharan Africa countries between 2019 and 2021: An ecological analysis of PEPFAR Panorama cervical cancer program data

Abstract

Introduction: Cervical cancer (CC) is the fourth main cause of death among women. Poor uptake of CC screening has indirect effects on increased mortality among women. Therefore, we employed the care cascade to understand the CC outcomes in sub-Saharan Africa (SSA) using the PEPFAR Panorama CC data collected between 2019 and 2021. Methods: A retrospective study using the PEPFAR Panorama CC data, from 13 countries from SSA, was performed. We calculated the proportions of women who were screened, those who were found to have positive results after screening for CC, and those who were linked to CC treatment. Results: A total of 2,312,541 were eligible for screening and of these, 1,429,925 (62%) were screened for CC. Of these, 162,758 (11%) were diagnosed with CC. Of these, 115,890 (71%) were provided with treatment. CC screening increased from 41% in 2019 to 90% in 2021. The CC diagnosis ranged from 8% in 2019 to 13% in 2021. CC treatment coverage increased from 64% in 2019 to 75% in 2021. Screening uptake, CC diagnosis, and CC treatment coverage varied by country and age of the women. Conclusion: There were variations in CC screening and treatment uptake for CC by country and age. With these inequalities in screening and coverage of treatment for CC, eliminating CC as stipulated in the sustainable development goals will remain a farfetched dream.