Cervical cancer screening and treatment of VIA positive lesions among women living with HIV in Nairobi and Kajiado counties, Kenya: results from a targeted intervention implemented under the USAID Fahari ya Jamii project in supported HIV clinics.

BACKGROUND: Cervical cancer is the leading cause of cancer-related deaths and the second most common cancer amongst females in Kenya. Women living with HIV (WLHIV) have a six-fold increased risk of developing cervical cancer than women in the general population. As of October 2021, only 23% (34/149) of Fahari ya Jamii (FYJ) project-supported HIV clinics in Nairobi and Kajiado Counties were offering cervical cancer screening for WLHIV. Visual inspection with acetic acid (VIA) positive lesions identified were being treated in only 7% (11/34) of facilities. The project implemented an intervention and sought to determine its outcome on cervical cancer screening and treatment uptake. METHODS: This was a retrospective analysis of data from 1st July 2022 to 30th June 2023. The intervention focused on building the capacity of service providers, determining cervical cancer screening eligibility using Kenya National eligibility screening guidelines, providing screening supplies and commodities, creating service demand through health education by mentor mothers and peer educators, providing screening services and on-site treatment of VIA positive lesions. WLHIV aged 25 to 49 years and receiving care in 64 USAID-FYJ-supported facilities in Nairobi and Kajiado Counties were included in the analyses. Descriptive analyses were performed for sociodemographic characteristics, screening and treatment uptake. RESULTS: A total of 52% (11,089/21,324) WLHIV received cervical cancer screening services, representing a five-fold increase from pre-intervention figures (2,186). The number of facilities offering screening services increased from 23% (34/149) to 43% (64/149). Of the women screened, 2% (245) VIA positive cervical lesions were identified. Treatment uptake improved from 38% pre-intervention to 90%, with 90% (220/245) of identified cases receiving appropriate treatment. The intervention successfully integrated screening into routine HIV care, facilitated same-day treatment in equipped facilities, and strengthened provider capacity, leading to sustained service delivery improvements. CONCLUSIONS: The intervention increased cervical cancer screening and treatment uptake for VIA positive lesions among WLHIV by integrating services into routine HIV care, enhancing provider training, and ensuring the availability of screening supplies. These findings highlight the potential for scaling up similar strategies in resource-limited settings. Sustained mentorship and continuous monitoring will be essential to further strengthen screening and treatment efforts toward cervical cancer elimination.