Assessing national cervical cancer screening guidelines: Results from an HIV testing clinic also screening for cervical cancer and HPV in Soweto, South Africa.

Kathryn L Hopkins,Kennedy Otwombe,Janan Dietrich,Khuthadzo E Hlongwane,Mireille Cheyip,Tanya Doherty,Jacobus Olivier,Maya Jaffer,Glenda E Gray

doi:10.1371/journal.pone.0255124

Abstract

ObjectiveA screening centre in Soweto, South Africa (SA), investigated high-risk human papillomavirus (HR-HPV), HIV, cervical cancer risk amongst women.MethodsThis cross-sectional study (June 2018-March 2019) describes screening results (Roche Linear Array HPV test and Pap smear liquid based cytology) and history of screening (known HIV status, antiretroviral therapy [ART] use, previous Pap smears). Data were stratified by age group (18–29, 30+ years), HIV status, Pap smear results and tested for statistical significance.ResultsOf 280 women, 20.4% were HIV-positive, 18.2% had abnormal Pap smears, 41.8% had HR-HPV. Of older women, 48.2% (n = 78/162) had never had a Pap smear. Of younger women, 89.0% (n = 105/118) never had a Pap smear, but had significantly more low-grade squamous intraepithelial lesions (LSIL) and other HR-HPV infection than older women (12.7%[n = 15/118] vs 4.9%[n = 8/162], p = 0.0193; and 49.2%[n = 58/118] vs 29.0%[n = 47/162], p = 0.0006; respectively). HIV-positive women had more abnormal cytology results and infection with other HR-HPV types or co-infection with other HR-HPV type(s)/HPV-16 compared to HIV-negative women (35.1%[n = 20/57] vs 13.9%[n = 31/223], p = 0.0002; 56.1%[n = 32/57] vs 32.7%[n = 73/223], p = 0.001; and 12.3%[n = 7/57] vs 4.9%[n = 11/223], p = 0.044; respectively). Of 57 HIV-positive women, 45.6% (n = 26) already knew their HIV status; of which 69.2% were on ART and 34.6% never had a Pap smear.ConclusionSouth African women have high rates of HIV, Pap smear abnormalities and HR-HPV, with low cervical cancer screening coverage. SA cervical cancer screening policy excludes (undiagnosed) HIV-positive and HIV-negative women <30 years, both populations found to have high prevalence of HR-HPV. HPV-based primary screening from 25 years could improve outcomes.

Highlights

In South Africa, cervical cancer is the most common cancer in women aged between 15–44 years [1], as well as the number one cause of cancer deaths among women of all ages [2]
89.0% (n = 105/118) never had a Pap smear, but had significantly more low-grade squamous intraepithelial lesions (LSIL) and other Highrisk human papillomavirus (HR-HPV) infection than older women (12.7%[n = 15/118] vs 4.9%[n = 8/162], p = 0.0193; and 49.2%[n = 58/118] vs 29.0%[n = 47/ 162], p = 0.0006; respectively)
HIV-positive women had more abnormal cytology results and infection with other HR-HPV types or co-infection with other HR-HPV type(s)/HPV-16 compared to HIV-negative women (35.1%[n = 20/57] vs 13.9%[n = 31/223], p = 0.0002; 56.1%[n = 32/57] vs 32.7%[n = 73/223], p = 0.001; and 12.3%[n = 7/57] vs 4.9%[n = 11/ 223], p = 0.044; respectively)

Summary

Introduction

In South Africa, cervical cancer is the most common cancer in women aged between 15–44 years [1], as well as the number one cause of cancer deaths among women of all ages [2]. South Africa is the global epicentre of the HIV/AIDS epidemic, with an estimated 7.9 million people living with HIV (PLHIV) as of 2017 [6,7,8,9]. PLHIV are known to have a higher prevalence of HPV infection than their HIV-negative counterparts [4]. This is due to shared risk factors, including sexual behaviour patterns, as well as underlying changes in immune responses during HIV infection [3]. Studies have reported cervical cancer as a main disease affecting HIV-positive women residing within low and middle-income countries (LMICs) [3, 4]

Methods

Results

Conclusion