Grant: Project Grant

Cervical cancer is the number one cancer killing women in South Africa, a country at the epicenter of the HIV epidemic. Cervical cancer is caused by human papillomaviruses (HPV), which are vaccine-preventable infections. The World Health Organization has now set goals to eliminate cervical cancer. What might complicate elimination efforts in high HIV prevalence settings, however, is that people living with HIV are more susceptible to HPV and vice versa. These biological interactions affect the transmission dynamics of both viruses with important public health implications. When used at sufficient coverage, vaccines are powerful prevention tools because they protect those immunized and the wider population by limiting HPV spread and, eventually, cervical cancer. South Africa's HPV vaccination program currently only immunizes 4th grade schoolgirls. Though South Africa wishes to improve the program, they lack the necessary evidence and policy guidance about the benefits of different vaccination and screening strategies in a context of high HIV prevalence. Our overall objective is to fill this knowledge gap by investigating how to achieve cervical cancer elimination through HPV vaccination and cervical cancer screening in South Africa. Our proposed study combines state-of-the-art data and computer simulations of HIV/HPV transmission, to identify vaccination and screening strategies that can lead to cervical cancer elimination in South Africa (who to vaccinate? with which vaccine? how many doses?). We will also identify the strategies that would lead to faster cervical cancer elimination, determine which ones are most cost-effective, and investigate the specific impact of HIV transmission on elimination efforts. By drawing on the expertise of a multidisciplinary team of researchers in epidemiology, economics, and mathematical modeling, our results will help mitigate the double threat of HIV and HPV to one of sub-Saharan Africa's most vulnerable groups, women.