HIV & ART Impact on Cervical Cancer in Zambia

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.

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

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

John Andoh & Eliane Rohner
Graduate School for Health Sciences, University of Bern, Bern, Switzerland

John Andoh
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

Herbert Kapesa & Albert Manasyan
Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Susan Citonje Msadabwe & Paul Kamfwa
University of Alabama at Birmingham, Birmingham, AL, USA

Albert Manasyan
Research Unit, Cancer Diseases Hospital, Lusaka, Zambia

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

Cliff Kerr
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland

Matthias Egger
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

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

Matthias Egger
Gender Equity Division, Bill and Melinda Gates Foundation, Seattle, WA, USA

Robyn Stuart
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.

Supplementary Material 1 (download DOCX )

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

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

Download citation

Received27 January 2026
Accepted12 August 2026
Published25 August 2026
DOIhttps://doi.org/10.1038/s41598-026-67046-3

Scientific Reports (2026) Cite this article