Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study.

Dhokotera, Tafadzwa; Riou, Julien; Bartels, Lina; Rohner, Eliane; Chammartin, Frédérique; Leigh, Johnson; Elvira, Singh; Victor, Olago; Mazvita, Sengayi-Muchengeti; Egger, Matthias; Bohlius, Julia; Konstantinoudis, Garyfallos (2021). Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study. International journal of health geographics, 20(1), p. 30. BioMed Central 10.1186/s12942-021-00283-z

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BACKGROUND

Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa.

METHODS

We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004-2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors.

RESULTS

We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health.

CONCLUSIONS

The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Dhokotera, Tafadzwa Gladys; Riou, Julien Yannis; Bartels, Lina; Rohner, Eliane; Chammartin, Frédérique Sophie; Egger, Matthias; Bohlius, Julia Friederike and Konstantinoudis, Garyfallos

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1476-072X

Publisher:

BioMed Central

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

07 Jul 2021 23:23

Last Modified:

08 Jul 2021 00:08

Publisher DOI:

10.1186/s12942-021-00283-z

PubMed ID:

34187465

BORIS DOI:

10.48350/157385

URI:

https://boris.unibe.ch/id/eprint/157385

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