Impact of HIV and Antiretroviral Therapy (ART) on Cervical Cancer Risk among Women at Maina Soko Medical Centre, Zambia

Abstract

Cervical cancer remains a leading cause of cancer mortality among women in Zambia, with high HIV prevalence creating a syndemic that elevates risk. Global strategies advocate integrating screening into HIV care, with antiretroviral therapy (ART) hypothesized to modify cervical cancer risk through immune reconstitution. This study evaluated an integrated screening service at a tertiary hospital and assessed the role of ART on cervical cancer risk among women living with HIV. A retrospective cross-sectional analysis was conducted using routine service records from Maina Soko Medical Centre, Lusaka. The cohort included 270 women screened with Visual Inspection with Acetic Acid (VIA) between October 2024 and November 2025. Data on demographics, HIV status, ART documentation, VIA results, and clinical management were extracted. Descriptive statistics and multivariable logistic regression identified factors associated with screen-positive results and assessed the relationship between ART and cervical abnormalities. Mean age was 45.1 years (SD = 12.4); 46.3% (n = 125) were HIV-positive. Overall VIA positivity was 5.6% (n = 15). Positivity was higher among HIV-positive women (7.2% vs. 4.1%), but not statistically significant after adjustment (aOR = 1.72, 95% CI: 0.60–4.96). Only 40.0% of VIA-positive women received immediate definitive treatment. Service delivery was episodic, with 44.4% of screenings in a two-month period. ART history was missing for 68.0% of HIV-positive women, constraining analysis of ART duration and cervical outcomes. Integrated screening reaches high-risk populations, but impact is undermined by treatment cascade gaps, inconsistent service delivery, and incomplete ART documentation. Findings suggest ART attenuates but does not eliminate cervical cancer risk among HIV-positive women. Urgent action is needed to transition from campaign-based to routine screening and close the treatment linkage gap. Keywords: Cervical Cancer, Screening, Visual Inspection with Acetic Acid (VIA), HIV, Antiretroviral Therapy (ART), Health Services Integration, Zambia