Efficiency of screening strategies to prevent cervical cancer in Eastern Africa

Cervical cancer (Cervix Uteri Carcinoma, CUC) is caused by an infection with the human papillomavirus (HPV), i.e., it involves both an infectious dimension (HPV infection) and the later development of a carcinoma as a chronic degenerative disease. Thus, it represents a rather unique case at the intersection of infectious and non-communicable diseases. A system dynamics model was developed to represent CUC disease progression and evaluate the economic determinants and cost-effectiveness of HPV self-sampling in Mozambique, Ethiopia, Uganda and Tanzania as model regions for Eastern African countries. The model was utilised to quantify and analyse the spread of the disease and depict the individual dynamics of the regions, and determined the factors which are most influential on the cost-effectiveness of a combined VIA and self-sampling scheme. The core finding of this simulation is that the integration of a HPV self-sampling scheme into an existing VIA regimen improves health outcomes by reducing the CUC burden, and will be cost-effective for the Eastern African countries (while not under all circumstances highly cost-effective), though it acts as a complementary tool rather than an automatic cost-saving panacea.