Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening.
Estimating the effect of HIV on cervical cancer elimination in South Africa: Comparative modelling of the impact of vaccination and screening.
复制标题
估计艾滋病毒对南非宫颈癌消除的影响：疫苗接种和筛查的影响。
DOI：
10.1016/j.eclinm.2022.101754
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发表时间：
2022-12
影响因子：
15.1
通讯作者：
Dalal, Shona
中科院分区：
文献类型：
--
作者：
Boily, Marie-Claude;Barnabas, Ruanne, V;Ronn, Minttu M.;Bayer, Cara J.;van Schalkwyk, Cari;Soni, Nirali;Rao, Darcy W.;Staadegaard, Lisa;Liu, Gui;Silhol, Romain;Brisson, Marc;Johnson, Leigh F.;Bloem, Paul;Gottlieb, Sami;Broutet, Nathalie;Dalal, Shona
2020年，世界卫生组织（世卫组织）发起了消除宫颈癌这一公共卫生问题的倡议。为了向艾滋病毒和宫颈癌高负担国家的全球努力提供信息，我们评估了南非人乳头瘤病毒（HPV）疫苗接种和宫颈癌筛查和治疗对宫颈癌的影响以及在2120年之前实现消除的潜力，考虑到艾滋病毒感染妇女（WLHIV）中HPV疾病进展更快，宫颈癌风险更高以及艾滋病毒干预措施。三个独立的传播动力学模型模拟HIV和HPV感染和疾病进展，用于预测三种情况对所有妇女宫颈癌发病率的影响：1)女孩接种疫苗（9-14岁），2)女孩接种疫苗加1次终身子宫颈筛查（35岁），3)女孩接种疫苗加2次终身子宫颈筛查（35岁和45岁），以及三种增强的WLHIV情景。4) 15-24岁的年轻人接种WLHIV疫苗，5)15-49岁的年轻人每三年进行一次WLHIV子宫颈筛查，或6)两者兼而有之。假设接种无价疫苗（针对HPV-16/18/31/33/45/52/58）的覆盖率为90%，终身保护为100%。宫颈癌筛查假设HPV检测，摄取率从45%（2023年），70%（2030年）增加到90%（2045年以上）。我们还假设到2030年达到联合国艾滋病规划署90-90-90艾滋病毒治疗和70%男性包皮环切的目标。我们研究了三个消除阈值：年龄标准化宫颈癌发病率低于每10万妇女年4或10，以及宫颈癌发病率降低85%。我们进行了敏感性分析，并给出了三种模型结果的年龄标准化预测中位数（模型之间的最小-最大值）。女孩接种疫苗可以将年龄标准化宫颈癌发病率从2020年的中位数47.6（40.9-79.2）降低到2120年的每10万妇女年4.5（3.2-6.3）例，与基础病例相比，25年和100年的年龄标准化累积宫颈癌病例分别平均减少4%和46%。增加两次终生筛查有助于在本世纪消除所有妇女的宫颈癌（2120例宫颈癌发病率：每10万妇女年3.6例（1.9-3.6例）），但在WLHIV中没有（10.8例（5.3-11.6）），并且与单独接种女孩疫苗相比，总体上避免了更多的累积癌症病例（25年≥45%，100年≥61%）。在女孩接种疫苗和2次终身子宫颈筛查中增加3年一次的宫颈癌筛查，进一步将年龄标准化宫颈癌发病率降低到每10万妇女年3.3例（1.8-3.6例），到2012年将在女孩接种疫苗和25年以上的2次终身子宫颈筛查中降低到5.2例（3.9-8.5例），并且在所有妇女中平均避免了12-13%的额外累积癌症病例，在WLHIV中平均避免了21-24%的癌症病例。为了消除这种疾病，需要长期的疫苗保护和使用无价疫苗。女孩的高HPV疫苗接种率和两次终身宫颈筛查可在本世纪末消除南非妇女的宫颈癌，并在短期和中期大幅减少所有妇女的病例和WLHIV。消除宫颈癌的WLHIV可能需要加强WLHIV的预防策略。尽管艾滋病毒干预措施扩大了，但WLHIV筛查仍然是减少发病率和减轻感染艾滋病毒和未感染艾滋病毒妇女之间宫颈癌负担差距的重要战略。,。……还有。
In 2020, the World Health Organization (WHO) launched its initiative to eliminate cervical cancer as a public health problem. To inform global efforts for countries with high HIV and cervical cancer burden, we assessed the impact of human papillomavirus (HPV) vaccination and cervical cancer screening and treatment in South Africa, on cervical cancer and the potential for achieving elimination before 2120, considering faster HPV disease progression and higher cervical cancer risk among women living with HIV(WLHIV) and HIV interventions. Three independent transmission-dynamic models simulating HIV and HPV infections and disease progression were used to predict the impact on cervical cancer incidence of three scenarios for all women: 1) girls' vaccination (9–14 years old), 2) girls' vaccination plus 1 lifetime cervical screen (at 35 years), and 3) girls’ vaccination plus 2 lifetime cervical screens (at 35 and 45 years) and three enhanced scenarios for WLHIV: 4) vaccination of young WLHIV aged 15–24 years, 5) three-yearly cervical screening of WLHIV aged 15–49 years, or 6) both. Vaccination assumed 90% coverage and 100% lifetime protection with the nonavalent vaccine (against HPV-16/18/31/33/45/52/58). Cervical cancer screening assumed HPV testing with uptake increasing from 45% (2023), 70% (2030) to 90% (2045+). We also assumed that UNAIDS 90-90-90 HIV treatment and 70% male circumcision targets are reached by 2030. We examined three elimination thresholds: age-standardised cervical cancer incidence rates below 4 or 10 per 100,000 women-years, and >85% reduction in cervical cancer incidence rate. We conducted sensitivity analyses and presented the median age-standardised predictions of outcomes of the three models (minimum–maximum across models). Girls' vaccination could reduce age-standardised cervical cancer incidence from a median of 47.6 (40.9–79.2) in 2020 to 4.5 (3.2–6.3) per 100,000 women-years by 2120, averting on average ∼4% and ∼46% of age-standardised cumulative cervical cancer cases over 25 and 100 years, respectively, compared to the basecase. Adding 2 lifetime screens helped achieve elimination over the century among all women (2120 cervical cancer incidence: 3.6 (1.9–3.6) per 100,000 women-years), but not among WLHIV (10.8 (5.3–11.6)), and averted more cumulative cancer cases overall (∼45% over 25 years and ∼61% over 100 years compared to basecase) than girls' vaccination alone. Adding three-yearly cervical screening among WLHIV (to girls' vaccination and 2 lifetime cervical screens) further reduced age-standardised cervical cancer incidence to 3.3 (1.8–3.6) per 100,000 women-years overall and to 5.2 (3.9–8.5) among WLHIV by 2120 and averted on average 12–13% additional cumulative cancer cases among all women and 21–24% among WLHIV than girls’ vaccination and 2 lifetime cervical screens over 25 years or longer. Long-term vaccine protection and using the nonavalent vaccine was required for elimination. High HPV vaccination coverage of girls and 2 lifetime cervical screens could eliminate cervical cancer among women overall in South Africa by the end of the century and substantially decrease cases among all women and WLHIV over the short and medium term. Cervical cancer elimination in WLHIV would likely require enhanced prevention strategies for WLHIV. Screening of WLHIV remains an important strategy to reduce incidence and alleviate disparities in cervical cancer burden between women with and without HIV, despite HIV interventions scale-up. . , . , . . . and the .
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影响因子：
51.1
作者：
de Sanjose, Silvia;Quint, Wim G. V.;Xavier Bosch, F.
通讯作者：
Xavier Bosch, F.
影响因子：
5.2
作者：
Amponsah-Dacosta E;Blose N;Nkwinika VV;Chepkurui V
通讯作者：
Chepkurui V
影响因子：
4.5
作者：
Burt LM;McCormak M;Lecuru F;Kanyike DM;Bvochora-Nsingo M;Ndlovu N;Scott AA;Anorlu RI;Sharma V;Plante M;Nyongesa C;Tigeneh W;Fakie N;Suneja G;Gaffney DK
通讯作者：
Gaffney DK
影响因子：
3.8
作者：
Campos, Nicole G.;Sharma, Monisha;Resch, Stephen
通讯作者：
Resch, Stephen
影响因子：
34.3
作者：
Arbyn, Marc;Weiderpass, Elisabete;Bray, Freddie
通讯作者：
Bray, Freddie