School of Mathematics and Statistics, UNSW Sydney, Sydney, New South Wales, Australia.
Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.
Int J Cancer. 2021 Jul 15;149(2):297-306. doi: 10.1002/ijc.33533. Epub 2021 Mar 24.
The World Health Organisation (WHO) has launched a strategic initiative for cervical cancer (CC) elimination which involves scaling up three interventions: human papillomavirus (HPV) vaccination, twice-lifetime HPV-screening screening and pre-cancer/cancer treatment by 2030. CC is challenging to control in countries with endemic human immunodeficiency virus (HIV), as women living with HIV (WLHIV) are at elevated risk of HPV infection, persistence and progression. This analysis estimated the impact of the elimination interventions on CC incidence and mortality but additionally considered more intensive screening for WLHIV, using Tanzania as an example. A dynamic HIV/HPV model was used to simulate the elimination strategy for vaccination, screening and pre-cancer/cancer treatment, with 3-yearly HPV-screening in WLHIV starting at age 25 years, in the context of sustained HIV control in Tanzania from 2020 to 2119. Without vaccination or HPV screening, CC incidence rates per 100 000 women are predicted to fall from 58.0 in 2020 to 41.6 (range: 39.1-44.7) in 2119, due to existing HIV control. HPV vaccination and twice-lifetime HPV-screening for the general population and 3-yearly screening for WLHIV, would reduce CC incidence to 1.3 (range: 1.3-2.5) by 2119, with elimination (<4/100 000) in 2076 (range: 2076-2092). CC mortality rates per 100 000 women are predicted to reach 1.1 (range: 1.1-2.1) with further reductions contingent on increased CC treatment access. Vaccination and 3-yearly HPV-screening for WLHIV is predicted to achieve elimination in the subgroup of WLHIV potentially as early as 2061 (range: 2061-2078), with a 2119 CC incidence rate of 1.7 (range: 1.7-3.3). Scaling-up vaccination and HPV-screening will substantially reduce CC incidence in Tanzania, with elimination predicted within a century. Three-yearly HPV-screening and HPV vaccination, at high coverage rates, would facilitate CC elimination among WLHIV, and thus accelerate elimination in the overall population.
世界卫生组织（WHO）发起了一项宫颈癌（CC）消除战略倡议，其中包括扩大三种干预措施的规模：人乳头瘤病毒（HPV）疫苗接种、一生中两次 HPV 筛查和癌前病变/癌症治疗。在人免疫缺陷病毒（HIV）流行的国家，宫颈癌的控制具有挑战性，因为感染 HIV 的妇女（WLHIV）感染 HPV、持续感染和进展的风险增加。本分析估计了消除干预措施对宫颈癌发病率和死亡率的影响，但还考虑了对 WLHIV 进行更密集的筛查，以坦桑尼亚为例。使用动态 HIV/HPV 模型模拟了疫苗接种、筛查和癌前病变/癌症治疗的消除策略，在 2020 年至 2119 年期间，坦桑尼亚持续控制 HIV 的情况下，从 25 岁开始对 WLHIV 每 3 年进行一次 HPV 筛查。如果没有疫苗接种或 HPV 筛查，预计宫颈癌发病率将从 2020 年的每 10 万妇女 58.0 例降至 2119 年的 41.6 例（范围：39.1-44.7），这是由于现有的 HIV 控制。HPV 疫苗接种和一生中两次 HPV 筛查用于普通人群，以及对 WLHIV 进行每 3 年一次的筛查，将使宫颈癌发病率在 2119 年降至 1.3（范围：1.3-2.5），2076 年（范围：2076-2092）消除。预计每 10 万妇女的宫颈癌死亡率将达到 1.1（范围：1.1-2.1），进一步降低取决于增加宫颈癌治疗的可及性。对 WLHIV 进行疫苗接种和每 3 年一次的 HPV 筛查预计将使这一亚组最早在 2061 年（范围：2061-2078）实现消除，2119 年的宫颈癌发病率为 1.7（范围：1.7-3.3）。扩大疫苗接种和 HPV 筛查将大大降低坦桑尼亚的宫颈癌发病率，预计在一个世纪内实现消除。高覆盖率的每 3 年一次的 HPV 筛查和 HPV 疫苗接种将有助于 WLHIV 中消除宫颈癌，从而加速整个人口的消除。
