Screen-and-Treat Cervical Cancer Screening Strategy Using High-Risk HPV Testing: Early Evaluation for Uganda

OBJECTIVES: As part of cervical cancer elimination strategy, The World Health Organization recommends a screen-and-treat approach with high-risk human papillomavirus (hrHPV) testing. In low- and middle-income countries, cervical cancer screening is often based on visual inspection with acetic acid (VIA), for which rapid transition to hrHPV testing is recommended. Uganda is a country with a high burden of cervical cancer, where the current VIA-based opportunistic screening policy has a low coverage. To inform potential implementation, this study aimed to assess the headroom of this strategy compared to existing screening policy and absence of screening at different screening uptake and treatment adherence levels.

METHODS: A previously developed microsimulation model was adapted. Model parameters were derived from available literature and expert opinion. Uptake of screening and precancerous lesion treatment adherence were varied from 10% to 100% for screening strategy. For each uptake and adherence level combination, headroom was estimated using net monetary benefit method under 0.5 GDP and 1 GDP per capita cost-effectiveness thresholds.

RESULTS: Uptake and adherence above 80% produced the highest headroom. Headroom at uptake and adherence levels around 50% was estimated at >100 USD compared to existing policy, suggesting considerable room for spending on implementation. Results were higher when compared to absence of screening, reaching 400 USD under 0.5 GDP threshold at 90% uptake. Negative headroom was found at some 30% uptake and 30% adherence levels under 0.5 GDP per capita threshold, suggesting the minimum required levels under the stricter threshold.

CONCLUSIONS: This early evaluation provides insights into potential uptake and adherence level targets for the recommended screen-and-treat strategy using hrHPV testing to remain cost-effective compared to the existing opportunistic VIA-based screening policy in Uganda, as well as absence of screening. Further evaluations are needed to assess potential costs of national rollout of the strategy in the context of headroom estimates.