Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
BMC Public Health. 2022 Aug 10;22(1):1530. doi: 10.1186/s12889-022-13827-0.
Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence.
We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1 2010 and March 31 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV.
We reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%).
Considerable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities.
宫颈癌（CC）是撒哈拉以南非洲地区女性癌症相关死亡的主要原因。它最常发生在感染艾滋病毒的妇女（WLHIV）中，被归类为艾滋病定义的疾病。最近世界卫生组织（WHO）的建议为 CC 预防政策提供了指导，包括对 WLHIV 的规范。我们系统地审查了撒哈拉以南地区 HIV 流行率最高的国家的 CC 预防和控制政策。
我们纳入了 2018 年 HIV 流行率≥10%的国家以及 2010 年 1 月 1 日至 2022 年 3 月 31 日期间发布的政策。我们通过 Medline 经 PubMed、国际癌症控制伙伴关系网站和纳入国家的国家政府网站搜索了相关政策文件。在线文件搜索辅以对每个纳入国家的专家咨询。我们综合了政策中规定的 HPV 疫苗接种、性教育、安全套使用、烟草控制、男性包皮环切术、宫颈筛查、宫颈癌前病变和癌症的诊断和治疗、监测机制以及为妇女提供服务的成本等方面，同时突出了 WLHIV 的特殊性。
我们审查了来自九个国家的 33 项政策文件。所有纳入的国家都有 CC 预防和控制政策，要么是作为单独的政策（77.8%），要么是作为癌症或非传染性疾病政策的一部分（22.2%），或者两者兼而有之（66.7%）。九个国家中有七个（77.8%）报告了 HPV 疫苗接种方面的情况。所有国家（100%）都计划制定或审查 CC 预防的信息、教育和宣传（IEC）材料，包括安全套使用和烟草控制。开始筛查的年龄和 WLHIV 的筛查间隔在各国之间有所不同。最常推荐的筛查和治疗方法分别是醋酸视觉检查（VIA）（88.9%）、巴氏涂片（77.8%）；冷冻疗法（100%）和环形电切术（LEEP）（88.9%）。很少有国家报告按 HIV 状况细分的全球监测 CC 方案指标。在三个国家（33.3%）中，CC 预防和护理政策包括各个阶段的服务成本。
撒哈拉以南非洲地区在制定 CC 预防和控制政策方面取得了相当大的进展。然而，在 HIV 负担沉重的国家，需要针对 WLHIV 的具体需求调整这些政策。各国可以考虑利用最近的世卫组织 CC 预防指南更新政策，同时使其适应国情现实。
