Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
J Int AIDS Soc. 2023 May;26(5):e26090. doi: 10.1002/jia2.26090.
Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We aimed to summarize the lifetime prevalence and adherence rate of cervical cancer screening among WLWH across low- and middle-income countries (LMICs), and high-income countries (HICs).
We systematically searched PubMed, Web of Science and Embase for studies published between database inception and 2 September 2022, without language or geographical restrictions. Those reporting the lifetime prevalence and/or adherence rate of cervical cancer screening among WLWH were included. Pooled estimates across LMICs and HICs were obtained using DerSimonian-Laird random-effects models. When the number of eligible studies was greater than 10, we further conducted stratified analyses by the World Health Organization (WHO) region, setting (rural vs. urban), investigation year, screening method, type of cervical cancer screening programme, age and education level.
Among the 63 included articles, 26 provided data on lifetime prevalence, 24 on adherence rate and 13 on both. The pooled lifetime prevalence in LMICs was 30.2% (95% confidence interval [CI]: 21.0-41.3), compared to 92.4% in HICs (95% CI: 89.6-94.6). The pooled adherence rate was 20.1% in LMICs (95% CI: 16.4-24.3) and 59.5% in HICs (95% CI: 51.2-67.2).
There was a large gap in cervical cancer screening among WLWH between LMICs and HICs. Further analysis found that those in LMICs had higher lifetime prevalence in subgroups with urban settings, with older age and with higher education levels; and those in HICs had higher adherence in subgroups with younger age and with higher education levels.
Cervical cancer screening among WLWH falls considerably short of the WHO's goal. There should be continuous efforts to further increase screening among these women, especially those residing in the rural areas of LMICs and with lower education levels.
感染艾滋病毒的女性（WLWH）更有可能患上宫颈癌。筛查和现有的医疗保健可以有效降低其发病率和死亡率。我们旨在总结中低收入国家（LMICs）和高收入国家（HICs）中 WLWH 的宫颈癌筛查终生患病率和依从率。
我们系统地在 PubMed、Web of Science 和 Embase 上搜索了自数据库成立至 2022 年 9 月 2 日期间发表的研究，没有语言或地理限制。包括报告 WLWH 宫颈癌筛查终生患病率和/或依从率的研究。使用 DerSimonian-Laird 随机效应模型获得中低收入国家和高收入国家的汇总估计值。如果合格研究的数量大于 10，则进一步按世界卫生组织（WHO）区域、设置（农村与城市）、调查年份、筛查方法、宫颈癌筛查方案类型、年龄和教育水平进行分层分析。
在 63 篇入选文章中，有 26 篇提供了关于终生患病率的数据，24 篇提供了关于依从率的数据，13 篇同时提供了关于终生患病率和依从率的数据。中低收入国家的终生患病率为 30.2%（95%置信区间 [CI]：21.0-41.3），而高收入国家为 92.4%（95% CI：89.6-94.6）。中低收入国家的依从率为 20.1%（95% CI：16.4-24.3），高收入国家为 59.5%（95% CI：51.2-67.2）。
中低收入国家和高收入国家之间的 WLWH 宫颈癌筛查存在巨大差距。进一步分析发现，城市地区、年龄较大和教育程度较高的中低收入国家妇女终生患病率较高；而高收入国家妇女年龄较小和教育程度较高的，其依从率较高。
WLWH 的宫颈癌筛查远远落后于世卫组织的目标。应继续努力，进一步增加这些妇女的筛查率，特别是中低收入国家农村地区和教育程度较低的妇女。
