Cervical cancer screening among women living with HIV

Export Indicator

Proportion of women living with HIV who report being screened for cervical cancer using any of the following methods: visual inspection with acetic acid (VIA), Pap smear or human papillomavirus (HPV) test
What it measures

Proportion of women living with HIV screened for cervical cancer

Rationale

With an estimated 570 000 cases and 311 000 deaths worldwide in 2018, cervical cancer ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer deaths among women. It is the second most common type of cancer among women living in low- and middle-income countries.

In high-income countries, programmes are in place that enable women to get screened, making most precancerous lesions identifiable at stages when they can easily be treated and cured. Achieving high coverage of screening of women - and treatment of precancerous lesions detected by screening - can ensure a low incidence of invasive cervical cancer in high-income countries.

Women living with HIV are more vulnerable than HIV-negative women to being affected by cervical cancer and to developing invasive cancer. Invasive cervical cancer is an AIDS-defining condition and the most common cancer among women living with HIV. Compared to women not living with HIV, women living with HIV are up to five times more likely to develop invasive cervical cancer. For these reasons, screening women living with HIV is important. This can prevent up to 80% of the cases of cervical cancer in these countries.

Numerator

Number of women living with HIV who report ever having had a screening test for cervical cancer using any of these methods: VIA, Pap smear and HPV test.

Denominator

All women respondents living with HIV

Calculation

Numerator/denominator

Method of measurement
  • Nationally representative population-based surveys
  • Programmatic data: If you do not have the number of women living with HIV (aged 30–49 years) who have ever been screened for cervical cancer, you also can provide the number of women who tested positive for HIV among all women who were screened for cervical  cancer.
Measurement frequency

Data should be collected at least every five years

Disaggregation
  • Age (15-29, 30–49).
  • Tested in the last year.
Strengths and weaknesses

Potential limitations include bias through self-report, including mistakenly assuming that any pelvic exam was a test for cervical cancer, and the limited validity of survey instruments.

Further information
Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, WHO Sixty-Sixth World Health Assembly, WHA66.10, World Health Organization (http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf).
 
Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization; 2013 (https://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng...).
 
Noncommunicable diseases global monitoring framework: indicator definitions and specifications. Geneva: World Health Organization; 2014
 
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre , Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;0:1-31.
 
Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization; 2013
 
Comprehensive cervical cancer control: a guide to essential practice. 2nd ed. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/144785/9789241548953_en...).
 
Related Indicators
 
ST.3 Cervical cancer screening among women living with HIV, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).
 
CXCA_SCRN, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).