Table 1.
Parameters for CC screening and treatment options
| Parameter | Description | Value (%) | Reference |
| Diagnostic performance | |||
| VIA | Values specific for detection of CIN 2+ lesions among WHIV in Kenya, irrespective of age or stage of cervical abnormality. | 28 | |
| Sensitivity | 62.70 | ||
| Specificity | 65.90 | ||
| HPV-DNA | |||
| Sensitivity | 83.60 | ||
| Specificity | 55.70 | ||
| Treatment efficacy | |||
| Cryo (eligible lesions)* | Values specific to WHIV in Kenya, irrespective of age or stage of cervical abnormality. | 70 | 20 |
| Cryo (ineligible lesions)* | Efficacy was defined as the probability of remaining cervical disease free at 24 months after treatment. | 35 | Assumed |
| LEEP (Cryo ineligible)* | For Cryo-ineligible lesions, the model assumed efficacy of Cryo to be half, in absence of empirical data. | 80.20 | 21 |
| Proportion of Cryo-ineligible* lesions | |||
| CIN 1 | CIN 1 and CIS values were assumed. CIN 2/3 value from an implementation study from the Zambia, specifically using VIA without digital enhancement or other means for increased sensitivity. | 0 | 43 |
| CIN 2/3 | 16.70 | ||
| CIS | 100 | ||
| Individuals refusing CC services | Averaged value from two Kenyan surveys, one of which specifically included diagnosed WHIV in its sample. | 13 | 22 23 |
| LTFU | |||
| From testing with HPV-DNA to obtaining of results | Testing with HPV-DNA assumed to require two clinic visits (one for testing and one to obtaining results). | 25 | 9 10 |
| From obtaining results (either with VIA or HPV-DNA) to treatment with LEEP | Treatment with LEEP assumed to require referral to a specialised clinic. | 49 | |
*The model assumed that 16.7% of individuals with CIN 2/3 status and that all with CIS and CC status had signs of Cryo ineligibility. Per clinical practice guidelines, Cryo-eligible lesions are those that do not have signs of invasive cancer (eg, bleeding), that are visible in their entirety, that do not extend more than 2–3 mm into the endocervical canal (which should be normal in appearance) and that can be fully covered by the Cryo probe.
CC, cervical cancer; CIN, cervical intraepithelial neoplasia; CIS, carcinoma in situ; Cryo, cryotherapy; HPV, human papillomavirus; LEEP, loop excision electrical procedure; LTFU, loss to follow-up; VIA, visual inspection with acetic acid; WHIV, women living with HIV.