Cervical Cancer Screening Cascade in Côte d'Ivoire: A Decade of Real-World Program Evaluation According to HIV Status

We assessed progress toward WHO 2030 Cervical Cancer (CC) elimination targets including 70% coverage for CC screening and 90% of precancerous lesions treated according to HIV status in Côte d'Ivoire during the 2010-2021 period.

A national CC screening registry was initiated in Côte d'Ivoire since 2010, collecting individual-level data from all health facilities offering visual inspection with acetic acid (VIA). The CC screening coverage was estimated based on the 2021 population census and the HIV national database in women aged 25-49 years from the general population and in women with HIV (WLHIV). CC screening and care cascade indicators were documented over time and compared according to HIV status. Access to same-day cryotherapy and associated factors were analyzed through a logistic regression model.

A total of 66,268 women received CC screening, with 11,251 (17.0%) being WLHIV. The estimated CC screening coverage was 4.4% (2.6-5.2), rising to 13.9% (13.5-15.3) in WLHIV. Overall, VIA positivity was 6.4% (6.2-6.5) and was higher in WLHIV (9.1% [8.6-9.7]), P < .001. Among VIA-positive women, 3,500 (83.1%) were eligible for same-day cryotherapy. Access to cryotherapy was 59.1%, declining over time from 71.7% before 2015 to 51.9% in 2021. Access to cryotherapy was higher in WLHIV (aOR, 1.55 [95% CI, 1.32 to 1.84]) and women screened in secondary-level (aOR, 1.82 [95% CI, 1.49 to 2.23]) or tertiary-level facilities (aOR, 1.79 [95% CI, 1.54 to 2.09]) versus primary level.

Despite major achievements in this 11-year implementation of the CC screening program in Côte d'Ivoire, performances remained low regardless of HIV status and far from elimination targets in 2021. These findings underline the need to endorse new screening strategies based on HPV testing and thermal ablation treatment at a national level.