Modelling the impact of prevention strategies on cervical cancer incidence in South Africa.

Publisher: Wiley-Liss Country of Publication: United States NLM ID: 0042124 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-0215 (Electronic) Linking ISSN: 00207136 NLM ISO Abbreviation: Int J Cancer Subsets: MEDLINE

Publication: 1995- : New York, NY : Wiley-Liss
Original Publication: 1966-1984 : Genève : International Union Against Cancer

Models, Statistical*; Alphapapillomavirus/*drug effects ; HIV/*drug effects ; HIV Infections/*prevention & control ; Papillomavirus Infections/*prevention & control ; Uterine Cervical Neoplasms/*epidemiology; AIDS Vaccines/administration & dosage ; Adult ; Aged ; Alphapapillomavirus/isolation & purification ; Early Detection of Cancer/methods ; Female ; Follow-Up Studies ; HIV/isolation & purification ; HIV Infections/complications ; HIV Infections/virology ; Humans ; Incidence ; Middle Aged ; Papillomavirus Infections/complications ; Papillomavirus Infections/virology ; Papillomavirus Vaccines/administration & dosage ; Prognosis ; South Africa/epidemiology ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/virology ; Young Adult

In 2020, the World Health Organisation (WHO) published a strategy to eliminate cervical cancer as a public health concern. In South Africa, despite having a national screening policy in place since 2000, diagnosed cervical cancer incidence has shown no signs of decline. We extend a previously developed individual-based model for human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection to include progression to cervical cancer. The model accounts for future reductions in HIV incidence and prevalence and includes a detailed cervical cancer screening algorithm, based on individual-level data from the public health sector. We estimate the impact of the current prevention programme and alternative screening scenarios on cervical cancer incidence. The South African screening programme prevented 8600 (95%CI 4700-12 300) cervical cancer cases between 2000 and 2019. At current levels of prevention (status quo vaccination, screening, and treatment), age-standardised cervical cancer incidence will reduce from 49.4 per 100 000 women (95%CI 36.6-67.2) in 2020, to 12.0 per 100 000 women (95%CI 8.0-17.2) in 2120. Reaching WHO's prevention targets by 2030 could help South Africa reach elimination (at the 10/100 000 threshold) by 2077 (94% probability of elimination by 2120). Using new screening technologies could reduce incidence to 4.7 per 100 000 women (95%CI 2.8-6.7) in 2120 (44% probability of elimination at the 4/100 000 threshold). HPV vaccination and decreasing HIV prevalence will substantially reduce cervical cancer incidence in the long term, but improvements to South Africa's current screening strategy will be required to prevent cases in the short term. Switching to new screening technologies will have the greatest impact.
(© 2021 UICC.)

World Health Organisation. Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem; 2020. https://www.who.int/publications/i/item/9789240014107. Accessed February 11, 2021.
Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144(8):1941-1953. https://doi.org/10.1002/ijc.31937.
National Cancer Registry National Institute for Occupational Health National Health Laboratory Service. Cancer in South Africa 2016 Full Report; 2020. https://www.nicd.ac.za/centres/national-cancer-registry/. Accessed July 16, 2020.
Olorunfemi G, Ndlovu N, Masukume G, Chikandiwa A, Pisa PT, Singh E. Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012). Int J Cancer. 2018;143(9):2238-2249. https://doi.org/10.1002/ijc.31610.
Massyn N, Day C, Ndlovu N, Padayachee T, eds. District Health Barometer 2019/20; 2021. https://www.hst.org.za/publications/Pages/HSTDistrictHealthBarometer.aspx. Accessed June 25, 2021.
Jassat W. An Evaluation of the Cervical Screening Programme in Johannesburg Metro District, Gauteng Province; 2010. http://hdl.handle.net/10539/8998 Accessed June 25, 2021.
Blanckenberg N, Oettle C, Conradie H, Krige F. Impact of the introduction of a colposcopy service in a rural South African sub-district on uptake of colposcopy. S Afr J Obstet Gynaecol. 2013;19(3):81-85. https://doi.org/10.7196/SAJOG.388.
Knegt Y. Audit of cervical cancer screening and colposcopy attendance in rural South Africa. Afr J Reprod Health. 2014;18(4):70-78.
Moodley J, Kawonga M, Bradley J, Hoffman M. Challenges in implementing a cervical screening program in South Africa. Cancer Detect Prev. 2006;30(4):361-368. https://doi.org/10.1016/j.cdp.2006.07.005.
Delany-Moretlwe S, Kelley KF, James S, et al. Human papillomavirus vaccine introduction in South Africa: implementation lessons from an evaluation of the National School-Based Vaccination Campaign. Glob Heal Sci Pract. 2018;6(3):425-438. https://doi.org/10.9745/GHSP-D-18-00090.
World Health Organization. Immunization, Vaccines and Biologicals; 2020. https://www.who.int/immunization/monitoring_surveillance/data/en/. Accessed October 24, 2020.
Sinanovic E, Moodley J, Barone M, Mall S, Cleary S, Harries J. The potential cost-effectiveness of adding a human papillomavirus vaccine to the cervical cancer screening programme in South Africa. Vaccine. 2009;27(44):6196-6202. https://doi.org/10.1016/j.vaccine.2009.08.004.
Li X, Stander MP, Van Kriekinge G, Demarteau N. Cost-effectiveness analysis of human papillomavirus vaccination in South Africa accounting for human immunodeficiency virus prevalence. BMC Infect Dis. 2015;15(1):1-18. https://doi.org/10.1186/s12879-015-1295-z.
Tan N, Sharma M, Winer R, Galloway D, Rees H, Barnabas RV. Model-estimated effectiveness of single dose 9-valent HPV vaccination for HIV-positive and HIV-negative females in South Africa. Vaccine. 2018;36(32):4830-4836. https://doi.org/10.1016/j.vaccine.2018.02.023.
Johnson LF, Geffen N. A comparison of two mathematical modeling frameworks for evaluating sexually transmitted infection epidemiology. Sex Transm Dis. 2016;43(3):139-146. https://doi.org/10.1097/OLQ.0000000000000412.
van Schalkwyk C, Moodley J, Welte A, Johnson LF. Estimated impact of human papillomavirus vaccines on infection burden: the effect of structural assumptions. Vaccine. 2019;37(36):5460-5465. https://doi.org/10.1016/j.vaccine.2019.06.013.
van Schalkwyk C, Moodley J, Welte A, Johnson LF. Are associations between HIV and human papillomavirus transmission due to behavioural confounding or biological effects? Sex Transm Infect. 2019;95(2):122-128. https://doi.org/10.1136/sextrans-2018-053558.
South African Department of Health. Cervical Cancer Prevention and Control; 2017. http://www.health.gov.za/index.php/2014-08-15-12-53-24?download=1393:cervical-cancer-policy-pdf. Accessed October 8, 2020.
Brisson M, Kim JJ, Canfell K, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395(10224):575-590. https://doi.org/10.1016/S0140-6736(20)30068-4.
McDonald AC, Tergas AI, Kuhn L, Denny L, Wright TC. Distribution of human papillomavirus genotypes among HIV-positive and HIV-negative women in Cape Town, South Africa. Front Oncol. 2014;4(March):48. https://doi.org/10.3389/fonc.2014.00048.
Kuhn L, Saidu R, Boa R, et al. Clinical evaluation of modifications to a human papillomavirus assay to optimise its utility for cervical cancer screening in low-resource settings: a diagnostic accuracy study. Lancet Glob Health. 2020;8(2):e296-e304. https://doi.org/10.1016/S2214-109X(19)30527-3.
Denny L, Kuhn L, Pollack A, Wainwright H, Wright TC. Evaluation of alternative methods of cervical cancer screening for resource-poor settings. Cancer. 2000;89(4):826-833. https://doi.org/10.1002/1097-0142(20000815)89:4<826::AID-CNCR15>3.0.CO;2-5.
Cronjé HS, Parham GP, Cooreman BF, de Beer A, Divall P, Bam RH. A comparison of four screening methods for cervical neoplasia in a developing country. Am J Obstet Gynecol. 2003;188(2):395-400.
Lomalisa P, Smith T, Guidozzi F. Human immunodeficiency virus infection and invasive cervical cancer in South Africa. Gynecol Oncol. 2000;77:460-463. https://doi.org/10.1006/gyno.2000.5775.
Snyman L, Herbst U. Reasons why unscreened patients with cervical cancer present with advanced stage disease. S Afr J Gynaecol Oncol. 2013;5(1):16-20. https://doi.org/10.1080/20742835.2013.11441203.
Mbodi L, Adam Y. Reasons Why Women Present With Late Stages of Cervical Cancer at Chris Hani Baragwanath Academic Hospital; 2016. http://hdl.handle.net/10539/21401. Accessed June 25, 2021.
Sabulei C, Maree J. An exploration into the quality of life of women treated for cervical cancer. Curationis. 2019;42(1):1-9. https://doi.org/10.4102/curationis.v42i1.1982.
National Cancer Registry South Africa. Ekurhuleni Population-Based Cancer Registry Annual Report 2018; 2020. www.ncr.ac.za. Accessed June 25, 2021.
Somdyala NIM, Bradshaw D, Dhansay MA, Stefan DC. Increasing cervical cancer incidence in rural Eastern Cape Province of South Africa from 1998 to 2012: a population-based cancer registry study. JCO Glob Oncol. 2020;6:1-8. https://doi.org/10.1200/JGO.19.00198.
South African Department of Health. National Guideline for Cervical Cancer Screening Programme; 2000. http://www.kznhealth.gov.za/cervicalcancer.pdf. Accessed November 27, 2019.
Boulle A, Heekes A, Tiffin N, et al. Data centre profile: the provincial health data Centre of the Western Cape Province, South Africa. Int J Popul Data Sci. 2019;4(2). https://doi.org/10.23889/ijpds.v4i2.1143.
Kocken M, Helmerhorst TJM, Berkhof J, et al. Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study. Lancet Oncol. 2011;12:441-450. https://doi.org/10.1016/S1470-2045(11)70078-X.
Kreimer AR, Katki HA, Schiffman M, Wheeler CM, Castle PE. Viral determinants of human papillomavirus persistence following loop electrical excision procedure treatment for cervical intraepithelial neoplasia grade 2 or 3. Cancer Epidemiol Biomarkers Prev. 2007;16(January):11-16. https://doi.org/10.1158/1055-9965.EPI-06-0710.
Paraskevaidis E, Arbyn M, Sotiriadis A, et al. The role of HPV DNA testing in the follow-up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev. 2004;30:205-211. https://doi.org/10.1016/j.ctrv.2003.07.008.
Brotherton JM, Budd A, Rompotis C, et al. Is one dose of human papillomavirus vaccine as effective as three?: a national cohort analysis. Papillomavirus Res. 2019;8(July):100177. https://doi.org/10.1016/j.pvr.2019.100177.
Kreimer AR, Struyf F, Del Rosario-Raymundo MR, et al. Efficacy of fewer than three doses of an HPV-16/18 AS04-adjuvanted vaccine: combined analysis of data from the Costa Rica vaccine and PATRICIA trials. Lancet Oncol. 2015;16:775-786. https://doi.org/10.1016/S1470-2045(15)00047-9.
Kreimer AR, Sampson JN, Porras C, et al. Evaluation of durability of a single dose of the bivalent HPV vaccine: the CVT trial. J Natl Cancer Inst. 2020;112:1-9. https://doi.org/10.1093/jnci/djaa011.
Denny L, Hendricks B, Gordon C, et al. Safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine in HIV-positive women in South Africa: a partially-blind randomised placebo-controlled study. Vaccine. 2013;31(48):5745-5753. https://doi.org/10.1016/j.vaccine.2013.09.032.
Moscicki AB, Karalius B, Tassiopoulos K, et al. Human papillomavirus antibody levels and quadrivalent vaccine clinical effectiveness in perinatally human immunodeficiency virus-infected and exposed, uninfected youth. Clin Infect Dis. 2019;69(7):1183-1191. https://doi.org/10.1093/cid/ciy1040.
Johnson L, Dorrington R. Thembisa Version 4.2: A Model for Evaluating the Impact of HIV/AIDS in South Africa; 2019. www.thembisa.org. Accessed July 20, 2020.
UN Department of Economic and Social Affairs. World Population Prospects: 2017 Revision; 2017. https://population.un.org/wpp/Download/Standard/Population/. Accessed September 14, 2020.

Keywords: HIV; HPV vaccination; cervical cancer; individual-based model; screening

0 (AIDS Vaccines)
0 (Papillomavirus Vaccines)

Date Created: 20210624 Date Completed: 20210906 Latest Revision: 20210906

20221213

10.1002/ijc.33716

34164807