Potential Impact of Antiretroviral Therapy and Screening on Cervical Cancer Mortality in HIV-Positive Women in Sub-Saharan Africa A Simulation 英文参考文献.docVIP

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Potential Impact of Antiretroviral Therapy and Screening on Cervical Cancer Mortality in HIV-Positive Women in Sub-Saharan Africa A Simulation 英文参考文献.doc

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Potential Impact of Antiretroviral Therapy and Screening on Cervical Cancer Mortality in HIV-Positive Women in Sub-Saharan Africa A Simulation 英文参考文献

PotentialImpactofAntiretroviralTherapyandScreening onCervicalCancerMortalityinHIV-PositiveWomenin Sub-SaharanAfrica:ASimulation JuliusAtashili1*,JenniferS.Smith2,AdaoraA.Adimora2,JosephEron2,WilliamC.Miller2,EvanMyers3 1FacultyofHealthSciences,UniversityofBuea,Buea,Cameroon,2GillingsSchoolofGlobalPublicHealth,UniversityofNorthCarolinaatChapelHill,ChapelHill,North Carolina,UnitedStatesofAmerica,3DukeMedicalSchool,DukeUniversity,Durham,NorthCarolina,UnitedStatesofAmerica Abstract Background:Despitehavinghighcervicalcancerincidenceandmortalityrates,screeningforcervicalprecancerouslesions remainsinfrequentinsub-SaharanAfrica.TheneedtoscreenHIV-positivewomenbecauseofthehigherprevalenceand fasterprogressionofcervicalprecancerouslesionsmaybeheightenedbytheincreasedaccesstohighly-activeantiretroviral therapy (HAART). Policymakers need quantitative data on the effect of HAART and screening to better allocate limited resources.Ouraimwastoquantifythepotentialeffectoftheseinterventionsoncervicalcancermortality. MethodsandFindings:WeconstructedaMarkovstate-transitionmodelofacohortofHIV-positivewomeninCameroon. Publisheddataontheprevalence,progressionandregressionoflesionsaswellasmortalityratesfromHIV,cervicalcancer and other causes were incorporated into the model. We examined the potential impact, on cumulative cervical cancer mortality, of four possible scenarios: no HAART and no screening (NHNS), HAART and no screening (HNS), HAART and screeningonceonHAARTinitiation(HSHI),andHAARTandscreeningonceatage35(HS35).Ourmodelprojectedthat, compared to NHNS, lifetime cumulative cervical cancer mortality approximately doubled with HNS. It will require 262 women being screened at HAART initiation to prevent one cervical cancer death amongst women on HAART. The magnitudesoftheseeffectsweremostsensitivetotherateofprogressionofprecancerouslesions. Conclusions:Screening,evenwhendoneonce,hasthepotentialofreducingcervicalcancermortalityamongHIV-positive womeninAfrica.Themostfeasibleandcost-