Cervical cancer screening coverage increased in Malawi, Tanzania, Zambia, and Zimbabwe: Findings from sequential Population-based HIV Impact Assessment Surveys 2015-2017 and 2020-2023

BACKGROUND: Cervical cancer causes significant morbidity and mortality in low- and middle-income countries, yet it is a preventable disease. Population-based HIV impact assessments (PHIAs) provide data to evaluate national progress towards HIV epidemic control; some countries included questions about cervical cancer screening and treatment history in their PHIAs. By analyzing sequential results from PHIA surveys in Malawi, Tanzania, Zambia, and Zimbabwe from 2015-17 and 2020-2023, we assessed progress toward the WHO global cervical cancer elimination targets that call for 70% screening and 90% treatment coverage. METHODS: We calculated self-reported cervical cancer screening coverage by country and by age, residence, education, marital status, wealth quintile, and HIV status. We calculated screening positivity and the percentage who reported receiving treatment among those who screened positive. RESULTS: Cervical cancer screening coverage among all women 30-49 years of age increased by more than 50% in all countries from survey round 1 [8.3% (Tanzania)-19.8% (Zimbabwe)] to round 2 [12.6% (Tanzania)-37.3% (Zambia)]. Screening coverage at both timepoints and increases in coverage between surveys were higher among women with HIV compared with HIV-negative women in all four countries Reported treatment in the round 2 surveys ranged from 75.2% in Malawi to 93.6% in Zambia. CONCLUSION: Although we observed considerable progress between rounds of surveys, none of the countries were near the 70% screening target, and only Zambia achieved the 90% treatment target. With continued and expanded commitment, national cancer control programs and public health agencies can contribute to the progress towards global cervical cancer elimination.