The impact of HIV on cervical cancer elimination in KwaZulu-Natal: a comparative modeling analysis

Achieving cervical cancer (CC) elimination requires addressing disparities in CC burden for women living with HIV (WLHIV) and how disparities evolve in the context of antiretroviral therapy (ART) scale-up. To inform CC elimination for high HIV prevalence regions, we modeled the impact of HIV, HIV interventions, and CC interventions in KwaZulu-Natal, South Africa.

We used 2 independently developed, dynamic compartmental transmission models of HIV and human papillomavirus (DRIVE and Policy1-Cervix-HIV) calibrated to KwaZulu-Natal. We simulated: a counterfactual without HIV but with observed CC screening and vaccination; and scenarios sequentially adding condom use and voluntary medical male circumcision (VMMC); HIV; observed HIV and CC interventions (status quo); achieving United Nations Programme on HIV/AIDS HIV treatment targets; and achieving World Health Organization (WHO) CC elimination targets. The impact of each scenario was measured as the difference in CC incidence from the previous scenario. Results were reported from 2024 to 2124 as a range between the 2 models; CC elimination was WHO-defined as incidence <4/100 000 women-years.

For the status quo, CC incidence ranged from 61.30 to 78.96/100 000 women-years in 2024, with the highest incidence among WLHIV (126.8-192.0/100 000). HIV contributed an estimated 29.08-48.87 additional cases per 100 000. Neither model predicted elimination under status quo interventions, but achieving HIV treatment and CC elimination targets could reduce incidence to 1.42-6.25/100 000 women-years in 2124.

HIV is associated with a population-level increase in CC incidence. However, scaling up ART coverage and CC interventions is expected to significantly reduce the burden of CC overall and among WLHIV. These conclusions are consistent between both models and strengthened by the comparative modeling approach.