Geospatial Analysis of HIV Prevalence and Cervical Cancer Screening Coverage in Sub-Saharan Africa: Opportunities and...

Cervical cancer remains a leading cause of cancer mortality among women in sub-Saharan Africa, with HIV infection amplifying risk through immunosuppression. This geospatial analysis examines the alignment between HIV prevalence and cervical cancer screening (CCS) coverage in 4 high-burden countries (South Africa, Kenya, Mozambique, and Lesotho) using recent Demographic and Health Survey data (2016-2023/24).

Using nationally representative Demographic and Health Survey data sets from South Africa (2016), Kenya (2022), Mozambique (2022/23), and Lesotho (2023/24), this study used geospatial hotspot analysis to identify areas with high and low CCS coverage and their overlap with high HIV prevalence hotspots. RStudio was used to map and analyze spatial clusters.

Substantial geographic heterogeneity was observed within and across countries. In South Africa, HIV hotspots were concentrated in Gauteng and KwaZulu-Natal, with strong alignment between HIV and CCS in metropolitan centers; however, high screening intensity in the Western Cape contrasted with relatively lower HIV burden. In Kenya, the most pronounced convergence occurred in the Lake Victoria basin (Kisumu, Homa Bay, Siaya, and Migori), whereas central counties demonstrated high CCS activity despite lower HIV prevalence. Mozambique showed the clearest spatial concordance, with near-complete overlap of HIV and CCS hotspots in Maputo City, Maputo Province, and Gaza, alongside limited screening presence in central and northern high-burden areas. In Lesotho, HIV and CCS hotspots were largely colocated in Maseru and border districts, with additional moderate overlap in Mokhotlong and southern districts.

The analysis highlights where service integration might be working (overlap of HIV prevalence and CCS hotspots) and where urgent alignment is needed (HIV hotspots without CCS). Policymakers should invest in region-specific strategies, with greatest integration potential in Mozambique south, South African metros, and Kenya's Lake Victoria basin, while urgently addressing CCS gaps. Geographically tailored interventions are critical to accelerate progress toward World Health Organization's 90-70-90 cervical cancer elimination targets in high-prevalence settings.