ACCESS: Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services

Program Summary
Nigeria has one of the largest HIV epidemics in the world with 1.8 million people living with HIV infection. With
an estimated female population of 102 million and HIV prevalence of 1.6% among adult females, Nigeria has the
largest population of women and the 4th largest number of women living with HIV (WLHIV) in Africa. Although
access to antiretroviral therapy (ART) among WLHIV in Nigeria has increased over the years, with over 98% of
the 960,000 WLHIV on ART, AIDS-related mortality remains high. In 2020, 16,000 WLHIV died from AIDS-
related illnesses including cervical cancer. A pilot implementation program in Nigeria demonstrated that
leveraging the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supported HIV programs for the
provision of evidence-based cervical cancer screen-and-treat interventions in WLWH is feasible. The pilot
program demonstrated, however, that tailored implementation strategies will be needed to address specific
multilevel barriers along the cancer control continuum in order to address adoption, reach, and sustainability that
are necessary for successful scale-up. However, in many African countries with a high burden of both HIV and
cervical cancer, there is a paucity of evidence-based implementation strategies to inform effective integration of
HIV and cervical cancer services delivery. Objectives of this proposal are to: 1) Refine strategies to integrate
cervical cancer screening, treatment and management within existing comprehensive HIV treatment programs
and determine implementation readiness; 2) Determine the comparative effectiveness of a Core set of
implementation strategies versus Core+ enhanced implementation strategies; and 3) assess sustainment of the
integration of cervical cancer screening, treatment, and management intervention into HIV programs. We have
assembled a strong team from University of California San Diego; University of Nigeria, Nsukka and John
Hopkins University with expertise in implementation science, HIV care and research, and cancer care and
research. Our proposal is responsive to the NCI RFA and consistent with the World Health Organization global
plan of elimination of cervical cancer by 2030. If effective, the proposed project will result in a set of feasible,
culturally adaptable, and sustainable implementation strategies to integrate evidence-based cervical cancer
screening and treatment into HIV programs in order to improve the health and life expectancy of WLHIV.

Grant Number: 5U01CA275118-04
NIH Institute/Center: NIH
Principal Investigator: GREGORY AARONS