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The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study

Scientific Reports (2026Cite this article

Abstract

Cervical cancer is the leading cause of cancer death among women in Zambia, where widespread HIV infection elevates cervical cancer risk. However, HIV’s contribution to Zambia’s cervical cancer burden and the extent to which antiretroviral therapy (ART) has mitigated this burden, remain poorly quantified. We adapted HPVsim, an existing open-source mathematical model simulating human papillomavirus (HPV) and cervical cancer natural history, to capture the dual burden of cervical cancer and HIV in Zambian women. We extended HPVsim by incorporating country-specific HIV incidence data and modeled how HIV alters cervical disease progression through CD4 cell count-dependent modification of HPV susceptibility and disease severity. We calibrated the model to GLOBOCAN cervical cancer estimates and cervical cancer incidence rate ratios by HIV status estimated from the Zambian Cancer Registry. We estimated that by 2025, 49.9% of all cervical cancer cases in Zambia could be attributed to HIV co-infection. Although ART prevented at least an estimated 5.4% of cervical cancer cases nationally and 8.7% of cases among women with HIV, HIV remains a major driver of the cervical cancer burden. HIV-stratified prevention strategies will be essential for Zambia to achieve the World Health Organization’s cervical cancer elimination targets.

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Abbreviations

ART:

Antiretroviral therapy

DHS:

Demographic health survey

GLOBOCAN:

Global Cancer Observatory

HIV:

Human immunodeficiency virus

HPV:

Human papillomavirus

HPVsim:

Human papillomavirus simulator

IQR:

Interquartile range

IRR:

Incidence rate ratio

LMICs:

Low- and middle-income countries

UN:

United Nations

UNAIDS:

Joint United Nations Programme on HIV/AIDS

VIA:

Visual inspection with acetic acid

WHO:

World Health Organization

Acknowledgements

This study was supported by the Swiss Cancer Research foundation (grant number KFS-5447-08-2021) and by the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Cancer Institute; the National Institute of Mental Health; the National Institute on Drug Abuse; the National Heart, Lung and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Diabetes and Digestive and Kidney Diseases; the Fogarty International Center under grant number U01AI069924.

Simulations and calibrations were performed on UBELIX (https://www.id.unibe.ch/hpc), the HPC cluster at the University of Bern, Switzerland.

Funding

Open access funding provided by University of Bern

Author information

Authors and Affiliations

  1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

    John Andoh & Eliane Rohner

  2. Graduate School for Health Sciences, University of Bern, Bern, Switzerland

    John Andoh

  3. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

    Herbert Kapesa & Albert Manasyan

  4. Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia

    Susan Citonje Msadabwe & Paul Kamfwa

  5. University of Alabama at Birmingham, Birmingham, AL, USA

    Albert Manasyan

  6. Research Unit, Cancer Diseases Hospital, Lusaka, Zambia

    Watson Zulu

  7. Global Health Division, Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, USA

    Cliff Kerr

  8. Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland

    Matthias Egger

  9. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    Matthias Egger

  10. Centre for Integrated Data and Epidemiological Research, School of Public Health, University of Cape Town, Cape Town, South Africa

    Matthias Egger

  11. Gender Equity Division, Bill and Melinda Gates Foundation, Seattle, WA, USA

    Robyn Stuart

  12. South African Centre for Epidemiological Modeling and Analysis, Stellenbosch University, Stellenbosch, South Africa

    Cari van Schalkwyk

Corresponding author

Correspondence to John Andoh.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

About this article

Cite this article

Andoh, J., Kapesa, H., Msadabwe, S.C. et al. The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-67046-3

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  • Received27 January 2026

  • Accepted12 August 2026

  • Published25 August 2026

  • DOIhttps://doi.org/10.1038/s41598-026-67046-3



This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Source: Nature
https://www.nature.com/articles/s41598-026-67046-3

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