Undertreatment of Cervical Precancer Among Screen-Positive Women Living with HIV in Kenya
Xinyi Feng, Ramya Ginjupalli, Judith Lukhorito, David Karanja, Mark Mounir, Mary Nderitu, Millicent Masinde, Sue Siminski, Lu Mao, Vikrant Sahasrabuddhe, Nazha Diwan, Michael ChungPURPOSE
Cervical cancer remains a leading cause of cancer-related morbidity and mortality among women living with HIV (WLWH) in sub-Saharan Africa. Although screening coverage has improved, evidence on completion of post-screening diagnostic evaluation and treatment remains limited. We described screening results and the post-screening management cascade among WLWH receiving HIV care in Nairobi, Kenya.
METHODS
We analyzed Project CN001 data from the National Cancer Institute-funded CASCADE Clinical Trials Network at the Coptic Hope Center for Infectious Diseases in Nairobi. We included WLWH aged 25-49 years who underwent visual inspection with acetic acid (VIA) and/or high-risk human papillomavirus (hrHPV) testing between March 11, 2025, and January 16, 2026, with at least 1 month of follow-up. VIA-positive women with fully visualized transformation zones (TZ) were eligible for same-day thermal ablation; those with non-fully visualized TZ or suspicious findings were referred for colposcopy. hrHPV-positive women were recommended for VIA triage.
RESULTS
Among 988 WLWH screened with VIA (n = 857) and/or hrHPV testing (n = 136), median age was 41 years (IQR, 35-46), and median time since HIV diagnosis was 10.5 years (IQR, 5-16). Among VIA-screened women, 63 (7.4%) had VIA-positive or suspicious findings and 794 (92.6%) were VIA-negative. TZ distribution varied by age, with younger women more likely to have TZ1 and older women more likely to have TZ3. Among 63 women with VIA-positive or suspicious findings, 37 (58.7%) received same-day thermal ablation and 26 (41.3%) were referred for colposcopy. Only 4 referred women (15.4%) underwent colposcopy: CIN3 was detected in 1, CIN2 in 1, and no CIN in 2. The woman with CIN2 received LEEP/LLETZ 9 days after; the woman with CIN3 and the remaining 24 referred women received no treatment (96.2%). Among 136 women undergoing hrHPV testing, 31 (22.8%) were hrHPV-positive; only 5 (16.1%) underwent VIA triage, and all were VIA-negative.
CONCLUSION
Among WLWH engaged in HIV care in Kenya, screening uptake was high and same-day ablation was feasible. However, screen-positive women referred for further evaluation rarely completed it and often received no treatment. Reducing financial and logistical barriers and strengthening pragmatic screen-and-treat pathways are essential to improve cervical cancer prevention among WLWH.