Scaling-up Cervical Cancer Services for Women Living with HIV in Mozambique, October 2018–September 2023
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Background
Cervical cancer is the most common cancer among women in Mozambique. Women living with HIV (WLHIV) have a six times greater risk of developing cervical cancer. National guidelines call for annual screening of all HIV-positive women aged 20-49 years or below 20 years if she is sexually active and HIV-negative women aged 25-49 years, with follow-up after 1 year for HIV-positive and 3 years for HIV-negative women that screen negative. Women screened positive are referred to treatment with cryotherapy, thermal ablation, or loop electrosurgical excision procedure (LEEP). In 2021, HIV prevalence among women aged 15–49 years was estimated at 15.4%. We analyzed routine program data to describe the expansion of cervical cancer services and identify gaps in screening and treatment coverage among WLHIV since 2018.
Methods
We analyzed semi-annual, routinely collected programmatic data on cervical cancer screening and treatment services reported between 21 September 2018 to 20 March 2019 (585 sites reported) and 21 March to 20 September 2023 (610 sites reported). We verify rates of screening coverage (WLHIV screened divided by WLHIV on ART aged ≥15 years), screen positivity (WLHIV screened positive divided by number screened), and treatment (WLHIV treated for precancerous lesions divided by number screened positive).
Results
The screening coverage improved from 1.4% (10,596 screened/731,572 WLHIV on ART) in October 2018–March 2019 to 36.2% (395,609/1,094,033) in March–September 2023. In the same period, screen positivity rates increased from 8.1% (861/10,596) to 10.9% (43,290/395,614), and treatment rates increased from 59.9% (516/861) to 94.0% (40,677/43,290).
Conclusion
Access to cervical cancer services has improved dramatically for a large population of WLHIV. With increased screening, more WLHIV with pre-cancerous lesions have been found and treated, averting morbidity and mortality due to cervical cancer. Quality improvement strategies may further improve service delivery as the program expands to reach all eligible WLHIV in Mozambique.
