Availability of Cancer Screening Across <scp>HIV</scp> Treatment Sites in the <scp>IeDEA</scp> Consortium

Abstract

Cancer remains a leading cause of morbidity and mortality in people with HIV, and the importance of cancer screening increases as this population ages. In 2017, 2020, and 2023, cross-sectional surveys were conducted at HIV care sites across 5 continents within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We described cancer screening availability in 2023 and over time for cervical and anal cancer screening using generalized estimating equations with a logit link function to account for site clustering, rurality, and country income. Of the 220 sites in the 2023 survey, 61% (134/220) reported cervical cancer screening by cytology or human papillomavirus (HPV) testing on-site, and 88% (194/220) reported cervical cancer screening by any method, including visual inspection. At sites serving predominantly rural populations, 62% (29/47) exclusively performed screening by visual inspection. Overall, 23% (50/220) of sites performed cytology-based anal cancer screening on-site, and 16% (35/220) had availability of high-resolution anoscopy, either on-site or by referral. Screening for cancer of the liver, colon, lung, prostate, or breast (by imaging) were each available at less than 43% of sites. The odds of cervical cancer screening availability increased by 16% annually from 2017 through 2023 (aOR = 1.16, 95% CI: 1.07-1.27, p = 0.001), while the relative odds of anal cancer screening availability decreased by 9% annually (aOR = 0.91, 95% CI: 0.84-0.99, p = 0.023). Lack of trained staff was the most frequently reported barrier, followed by lack of equipment. Understanding current practices and capacity is essential for the continued integration of cancer prevention in HIV care.