Presentation (CTI)

OBJECTIVES: The burden of cervical cancer (CC) in East Africa is strongly linked to the high prevalence of HIV infections. Evidence suggests that integrating the HIV Universal Test and Treat (UTT) strategy into cervical cancer screening has improved screening rates among women living with HIV (WLHIV) in Tanzania. However, limited evidence exists on whether the UTT strategy is a cost-effective strategy for reducing the cervical cancer burden and related expenditures. This study evaluated the cost-effectiveness of the UTT strategy in downstaging cervical cancer at diagnosis among WLHIV in Tanzania.
METHODS: In a retrospective study of 1,023 HIV-positive women diagnosed with CC at the Ocean Road Cancer Institute (ORCI) before and after UTT implementation, we estimated program costs, compared the proportion of women presenting with early-stage CC, and used adjusted regression and marginal effects to assess effectiveness. Cost-effectiveness was estimated using the Incremental Cost-Effectiveness Ratio (ICER).
RESULTS: After adjusting for covariates, WLHIV diagnosed post-UTT had 1.6 times higher odds of early-stage diagnosis, reflecting an 11% increase in marginal effect (AOR = 1.63; marginal effect = 0.106; 95% CI: 0.02-0.19; P = 0.012). The ICER indicated that USD 38.06 was spent per 1% increase in early-stage CC diagnosis, approximately USD 4 per woman to downstage CC using the UTT strategy.
CONCLUSIONS: The UTT strategy is a cost-effective approach to downstaging cervical cancer among WLHIV. These findings has direct implications for similar regions and countries in Sub-Saharan Africa facing the dual epidemic burden of high HIV prevalence and high cervical cancer incidence.