No woman left behind: achieving cervical cancer elimination among women living with HIV.

Cervical cancer is the fourth most common malignancy in women of reproductive age globally. The burden of this disease is highest in low-income and middle-income countries, especially among women living with HIV. In 2018, WHO launched a global strategy to accelerate cervical cancer elimination through rapid scale-up of prophylactic vaccination, cervical screening, and treatment of precancers and cancers. This initiative was key in raising a call for action to address the stark global disparities in cervical cancer burden. However, achieving elimination of cervical cancer among women with HIV requires consideration of biological and social issues affecting this population. This Position Paper shows specific challenges and uncertainties on the way to cervical cancer elimination for women living with HIV and highlights the scarcity of evidence for the effect of interventions in this population. We argue that reaching equity of outcomes for women with HIV will require substantial advances in approaches to HPV vaccination and improved understanding of the long-term effectiveness of HPV vaccines in settings with high HIV burden cervical cancer, just as HIV, is affected by social and structural factors such as poverty, stigma, and gender discrimination, that place the elimination strategy at risk. Global efforts must, therefore, be galvanised to ensure women living with HIV have optimised interventions, given their substantial risk of this preventable malignancy.

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Déclaration de conflit d'intérêts

Declaration of interests SMG is a recipient of funds from Merck educational grants; receives consulting fees from Merck as a member of the Global Advisory Board for HPV; and receives honoraria and travel support for meetings from Merck Sharp & Dohme. SMG holds an unpaid position as the President of the International Papillomavirus Society; is an honorary board member of the Asia Oceania Research Organization on Genital Infections and Neoplasia; and is also a co-Chair of the Asia Pacific HPV Coalition. AJV is a recipient of funding from the Global Alliance for Chronic Diseases (GNT2009196)/National Health & Medical Research Council Australia, Minderoo Foundation (PS64872), and the NHMRC (Leadership Investigator Grant GNT2007901); and reports donated goods and materials from Cepheid USA outside of the submitted work. HR is a member of the WHO Strategic Advisory Group of Experts HPV Working Group and co-Chair of the HPV Single Dose Vaccine Evaluation Consortium; and is Chair of the South African Health Products Regulatory Board. All other authors declare no competing interests.