Project 466695

Cervical cancer (CC) is a major cause of mortality in women globally. CC disproportionately affects women in lower-income countries due to gender inequality, lack of access to effective and efficient healthcare, and limited health expenditures. The situation is exacerbated in high HIV prevalence countries due to the synergistic effect of HIV with Human Papillomavirus (HPV), the causative agent of CC, as women living with HIV have a higher probability of developing CC. The current major CC elimination strategies are vaccination against HPV and routine screening for precancerous cervical lesion. Though these strategies have been proven to decrease CC incidence and mortality in developed countries, the optimal CC elimination strategy in high HIV prevalence settings is yet to be determined. With limited health budgets, the affordability of such strategies needs to be considered.This project aims to examine the economic impacts of potential CC elimination strategies in South Africa, one of the countries with the highest HIV burden. Specifically, I will:1) evaluate the costs and conduct budget impact analyses of current and potential screening and vaccination strategies in South Africa; and2) conduct cost-effectiveness analyses of CC elimination strategies, considering HIV transmission dynamics, in South Africa. Leveraging several data sources, I will evaluate the costs and affordability of the potential strategies. I will then conduct cost-effectiveness analyses using a mathematical model of HIV and HPV co-transmission to determine the optimal strategy of CC elimination in high HIV prevalence settings. My results will guide global CC elimination recommendations and should prove an invaluable tool to address the double threat of HIV and HPV to women in sub-Saharan Africa.