HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres?

BACKGROUND

Women living with HIV (WLHIV) face a six-to-tenfold increased risk of cervical cancer due to higher HPV prevalence and persistence. Despite an estimated 1.05 million WLHIV in India and a vast National AIDS Control Programme (NACP) network, no organized cervical screening exists within this infrastructure.

OBJECTIVE

This pilot implementation project aimed to demonstrate a feasible and efficacious model for integrating cervical cancer prevention services, including HPV screening and a 'see and treat' approach, for WLHIV within or near ART centres in hard-to-reach Indian settings.

METHODS

A total of 368 WLHIV aged >21 years on ART from three centres were invited. 314 (85.3%) were screened using the COBAS 6800 high-risk HPV test. HPV-positive women were recalled for colposcopy using a portable digital device. A 'see and treat' approach was applied, using thermal ablation or LLETZ for minor/major lesions suggestive of precancer in field clinics.

RESULT: 76 of 314 screened women (24.2%) tested positive for high-risk HPV. 65 of 76 HPV positive women (85.5%) complied with colposcopy and treatment. Histology from these 65 women showed 17 high-grade squamous intraepithelial lesions (HSIL), 23 low-grade SIL (LSIL), and 2 invasive cancers. The overall prevalence of HSIL or worse lesions was 5.7% among screened WLHIV. High participation was observed despite logistical challenges.

CONCLUSION

The study confirms the significant burden of cervical neoplasia in WLHIV and demonstrates the feasibility and importance of integrating HPV screening and 'see and treat' services within or near existing ART centres using portable technologies. Leveraging the extensive NACP network offers a strategic opportunity for nationwide implementation, crucial for cervical cancer elimination efforts in this high-risk population.