abstract: 'Introduction: HIV and cervical cancer are intersecting epidemics that

  disproportionately affect one of the most vulnerable populations in the

  world: women in low-and middle-income countries (LMICs). Historically,

  the disparity in cervical cancer risk for women in LMICs has been due to

  the lack of organized screening and prevention programmes. In recent

  years, this risk has been augmented by the severity of the HIV epidemic

  in LMICs. HIV-positive women are at increased risk for developing

  cervical precancer and cancer, and while the introduction of

  antiretroviral therapy has dramatically improved life expectancies among

  HIV-positive women it has not been shown to improve cancer-related

  outcomes. Therefore, an increasing number of HIV-positive women are

  living in LMICs with limited or no access to cervical cancer screening

  programmes. In this commentary, we describe the gaps in cervical cancer

  prevention, the state of evidence for integrating cervical cancer

  prevention into HIV programmes and future directions for programme

  implementation and research.

  Discussion: Despite the biologic, behavioural and demographic overlap

  between HIV and cervical cancer, cervical cancer prevention has for the

  most part been left out of sexual and reproductive health (SRH) services

  for HIV-positive women. Lower cost primary and secondary prevention

  strategies for cervical cancer are becoming more widely available in

  LMICs, with increasing evidence for their efficacy and

  cost-effectiveness. Going forward, cervical cancer prevention must be

  considered a part of the essential package of SRH services for

  HIV-positive women. Effective cervical cancer prevention programmes will

  require a coordinated response from international policymakers and

  funders, national governments and community leaders. Leveraging the

  improvements in healthcare infrastructure created by the response to the

  global HIV epidemic through integration of services may be an effective

  way to make an impact to prevent cervical cancer among HIV-positive

  women, but more work remains to determine optimal approaches.

  Conclusions: Cervical cancer prevention is an essential part of

  comprehensive HIV care. In order to ensure maximal impact and

  cost-effectiveness, implementation strategies for screening programmes

  must be adapted and rigorously evaluated through a framework that

  includes equal participation with policymakers, programme planners and

  key stakeholders in the target communities.'
affiliation: 'Huchko, MJ (Corresponding Author), Mission Hall,550 16th St,Box 1224,
  San Francisco, CA 94158 USA.

  Huchko, Megan J.; Cohen, Craig R., Univ Calif San Francisco, Dept Obstet Gynecol
  \& Reprod Sci, San Francisco, CA 94143 USA.

  Maloba, May, Kenya Govt Med Res Ctr, Family AIDS Care \& Educ Serv, Kisumu, Kenya.

  Nakalembe, Miriam, Makerere Univ, Dept Obstet \& Gynaecol, Kampala, Uganda.

  Nakalembe, Miriam, Makerere Univ, Infect Dis Inst, Kampala, Uganda.'
author: Huchko, Megan J. and Maloba, May and Nakalembe, Miriam and Cohen, Craig R.
author-email: megan.huchko@ucsf.edu
author_list:
- family: Huchko
  given: Megan J.
- family: Maloba
  given: May
- family: Nakalembe
  given: Miriam
- family: Cohen
  given: Craig R.
da: '2023-09-28'
doi: 10.7448/IAS.18.6.20282
eissn: 1758-2652
files: []
journal: JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
keywords: 'cervical cancer prevention; HIV; integration; low- and middle-income

  countries'
keywords-plus: 'RANDOMIZED CONTROLLED-TRIAL; SUB-SAHARAN AFRICA; ANTIRETROVIRAL THERAPY;

  COST-EFFECTIVENESS; VISUAL INSPECTION; KENYA; INTEGRATION; INFECTION;

  INDIA; CARE'
language: English
month: DEC
number: '5'
number-of-cited-references: '48'
pages: 39-43
papis_id: 83658330c46ffb293390fb56cefbcb43
ref: Huchko2015timehas
researcherid-numbers: Huchko, Megan/S-6063-2019
times-cited: '3'
title: The time has come to make cervical cancer prevention an essential part of comprehensive
  sexual and reproductive health services for HIV-positive women in low-income countries
type: article
unique-id: WOS:000365969900006
usage-count-last-180-days: '0'
usage-count-since-2013: '11'
volume: '18'
web-of-science-categories: Immunology; Infectious Diseases
year: '2015'