ArticleJournal of acquired immune deficiency syndromes (1999)2018
Cost-Effectiveness of Cervical Cancer Screening in Women Living With HIV in South Africa: A Mathematical Modeling Study.
Article in Journal of acquired immune deficiency syndromes (1999), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A systematic review of economic evaluations of cervical cancer screening methods.Systematic reviews · 2022Pooled it
- Meta-synthesis and science mapping analysis of HIV/HPV co-infection: a global perspective with emphasis on Africa.Globalization and health · 2022Pooled it
- Economic evaluation of thermal ablation compared to cryotherapy and loop diathermy in a screen-and-treat approach to cervical cancer, Zambia.Bulletin of the World Health Organization · 2025Trial
- A Micro-costing Study of Community-Based Primary HPV Self-Sampling and Triage Test for Cervical Cancer Screening in Rural Cambodia.PharmacoEconomics - open · 2026Article
- Cost-effectiveness of cervical cancer screening among women living with HIV in India: study protocol.BMJ open · 2026Article
- Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay: A prospective screening cohort of women with and without HIV in Botswana.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Evaluating the Cost-Effectiveness of Cervical Cancer Screening and Treatment in Western Romania.Current oncology (Toronto, Ont.) · 2025Article
- Short-term costs and cost-efficiency of HPV triage strategies in a high HIV-prevalence setting: Evidence from Botswana.PloS one · 2025Article
- Human papilloma virus vaccination in the resource-limited settings of sub-Saharan Africa: Challenges and recommendations.Vaccine: X · 2024Review
- Cost-effectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic.Frontiers in oncology · 2024Article
- Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria.The Pan African medical journal · 2024Article
- Perceptions of and Preparedness for the Application of Pharmacoeconomics in Practice, among Final Year Bachelor of Pharmacy Students in South Africa: A National Cross-Sectional Study.Pharmacy (Basel, Switzerland) · 2023Article
- Mathematical Models for Evaluating Effectiveness and Cost-Effectiveness of Cervical Cancer Control Policies in Populations Including Women Living With Human Immunodeficiency Virus: A Scoping Review.Value in health regional issues · 2022Article
- Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa.International journal of cancer · 2022Article
- Article
- Clinical evaluation of modifications to a human papillomavirus assay to optimise its utility for cervical cancer screening in low-resource settings: a diagnostic accuracy study.The Lancet. Global health · 2020Article
- The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study.BMJ global health · 2020Article
- What next after GDP-based cost-effectiveness thresholds?Gates open research · 2020Article
- The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: A modelling study.PloS one · 2020Article
- HPV-FRAME: A consensus statement and quality framework for modelled evaluations of HPV-related cancer control.Papillomavirus research (Amsterdam, Netherlands) · 2019Article
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
backgroundWomen with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa.
methodsWe modified a mathematical model of HPV infection and cervical disease to reflect coinfection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at 1-, 2-, or 3-year intervals. Strategies with an ICER below South Africa's 2016 per capita gross domestic product (US$5270) were considered "cost-effective."
resultsHPV testing followed by treatment (test-and-treat) at 2-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56.6% with an ICER of US$3010 per year of life saved. Other cost-effective strategies included Pap (referral threshold: HSIL+) at 1-, 2-, and 3-year intervals, and HPV test-and-treat at 3-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives.
conclusionsConsidering per capita gross domestic product as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal.
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