review · PLoS Medicine
This study systematically analysed cervical cancer screening trends in sub-Saharan Africa from 2000 to 2020, using data from 52 surveys across 28 countries. It aimed to benchmark progress against the World Health Organisation's cervical cancer elimination strategy. Findings indicate that only an estimated 14% of women aged 30 to 49 had ever been screened for cervical cancer by 2020. While screening coverage remained constant in Eastern and Western/Central Africa, it increased in Southern Africa, which also showed higher overall coverage. Women living with HIV generally had higher or equal odds of screening. However, only 12% of women had been screened twice or more by age 45. The study concludes that overall screening coverage remains sub-optimal and has not significantly improved, highlighting the need for increased action to achieve elimination goals.
Cervical cancer is a major health burden in sub-Saharan Africa. Understanding screening coverage trends is crucial for evaluating the effectiveness of public health efforts and identifying areas where interventions are most needed to achieve the World Health Organisation's elimination targets.
This research provides epidemiological data on cervical cancer screening uptake, which is valuable for informing public health policy and programme design. It does not indicate a direct commercialisation pathway for a product or service. However, the findings could guide organisations involved in health programme implementation, funding, or technology development for screening services, by highlighting regions and populations with low coverage. This is early-stage research for policy and programme planning.
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BACKGROUND: Sub-Saharan Africa (SSA) has the highest cervical cancer (CC) burden globally-worsened by its HIV epidemics. In 2020, the World Health Organization (WHO) introduced a CC elimination strategy with goals for vaccination, screening, and treatment. To benchmark progress, we examined temporal trends in screening coverage, percent screened at least twice by the age of 45, screening coverage among women living with HIV (WLHIV), and pre-cancer treatment coverage in SSA. METHODS AND FINDINGS: We conducted a systematic analysis of cross-sectional population-based surveys. It included 52 surveys from 28 countries (2000 to 2020) with information on CC screening among women aged 25 to 49 years (N = 151,338 women). We estimated lifetime and past 3-year screening coverage by age, year, country, and HIV serostatus using a Bayesian multilevel model. Post-stratification and imputations were done to obtain aggregate national, regional, and SSA-level estimates. To measure re-screening by age 45, a life table model was developed. Finally, self-reported pre-cancer treatment coverage was pooled across surveys using a Bayesian meta-analysis. Overall, an estimated 14% (95% credible intervals [95% CrI]: 11% to 21%) of women aged 30 to 49 years had ever been screened for CC in 2020, with important regional and country-level differences. In Eastern and Western/Central Africa, regional screening coverages remained constant from 2000 to 2020 and WLHIV had greater odds of being screened compared to women without HIV. In Southern Africa, however, screening coverages increased and WLHIV had equal odds of screening. Notably this region was found to have higher screening coverage in comparison to other African regions. Rescreening rates were high among women who have already been screened; however, it was estimated that only 12% (95% CrI: 10% to 18%) of women had been screened twice or more by age 45 in 2020. Finally, treatment coverage among 4 countries with data was 84% (95% CrI: 70% to 95%). Limitations of our analyses include the paucity of data on screening modality and the few countries that had multiple surveys. CONCLUSION: Overall, CC screening coverage remains sub-optimal and did not improve much over the last 2 decades, outside of Southern Africa. Action is needed to increase screening coverage if CC elimination is to be achieved.
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DOI: 10.1371/journal.pmed.1004143
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