Identifying and Addressing Barriers in the Cervical Cancer Treatment Cascade among Women with HIV in South Africa

PROJECT SUMMARY/ABSTRACT The vast majority of women who develop and die from cervical cancer live in low- and middle-income countries.1 In sub-Saharan Africa, geographic inequities in rates of cervical cancer are fueled by high HIV incidence and prevalence among women with HIV (WWH). South Africa (SA) bears the greatest HIV burden in

the world2 and has the highest cervical cancer incidence rate globally;3 in SA, 53% of all cervical cancer cases are attributable to HIV.4 With increased attention paid to the importance of cervical cancer screening (which, in SA, is typically cytology-based via Pap smears),5 Pap smear screening rates have risen; as of 2018, 52% of

women had been screened,6 up from 18-25% in earlier studies.7 However, cervical cancer can only be prevented if patients are retained in care and subsequently treated. Alarmingly, only 26% of WWH who received high-risk abnormal Pap results completed medically-required follow-up and management within 18 months.8

To increase retention of WWH in the cervical cancer treatment cascade, it is imperative that we investigate the specific factors that negatively affect follow-up appointment attendance and engagement with necessary treatment. Without a nuanced understanding of barriers to retention and treatment across multiple levels, WWH

will continue to be at disproportionate risk for cervical cancer. A multi-level retention care intervention that is tailored to the unique needs of WWH who have recently received high-risk abnormal Pap results has strong potential to mitigate massive cervical cancer disparities. We now propose to conduct the formative work that is necessary to develop the novel intervention, which, in line

with PAR-21-341, will modify the complex, intersecting factors that contribute to cervical cancer development among WWH. In qualitative interviews with (1) WWH (n