Davidović, Maša (2024). Cancer prevention in women living with HIV in sub-Saharan Africa. (Thesis). Universität Bern, Bern
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Abstract
Sub-Saharan Africa is the epicenter of the HIV epidemic, where women are disproportionately affected compared to men. With widespread access to antiretroviral therapy (ART), life expectancy for those living with HIV has improved, allowing them to reach ages at which cancers may develop. Cervical and breast cancers are the leading causes of cancer-related morbidity and mortality among women in the region. Women living with HIV (WLHIV) face significant disparities in cervical and breast cancer care and outcomes. They are six times more likely to develop cervical cancer, often at a younger age than women without HIV. While WLHIV are not at increased risk for breast cancer, their survival outcomes are significantly worse. In this thesis, I explore disparities in cervical and breast cancer among WLHIV in sub-Saharan Africa, using the cancer prevention and care continuum as a framework to describe interventions across primary, secondary, and tertiary prevention. The overall aim of the thesis was to study the two most common cancers in women in sub-Saharan Africa – cervical and breast cancer – in the context of HIV. This thesis includes four studies: a Delphi consensus process to identify key indicators for monitoring cervical cancer services in HIV clinics in sub-Saharan Africa (Publication 1); a review of national cervical cancer control policies in African countries with high HIV prevalence (Publication 2); a facility-based survey of cervical cancer prevention and care services in HIV clinics in the region (Publication 3); and a national analysis of breast cancer characteristics among women with and without HIV in South Africa, using linked cancer and laboratory data (Publication 4). By addressing the intersecting challenges of HIV, cervical cancer, and breast cancer, this thesis makes a significant contribution to bridging critical knowledge gaps in cancer prevention and care for WLHIV in sub-Saharan Africa. It provides a foundation for evidence-based interventions, underscores the urgent need for holistic and integrated approaches to the dual burden of HIV and cancer, and emphasizes the importance of accessible and sustainable health interventions for cervical cancer elimination and effective breast cancer control. Finally, it calls for global commitment to mobilize political will, improve healthcare systems, and engage communities in working togeter to achieve the goals of the WHO initiatives in sub-Saharan Africa.
| Item Type: | Thesis |
|---|---|
| Dissertation Type: | Cumulative |
| Date of Defense: | 1 July 2024 |
| Subjects: | 300 Social sciences, sociology & anthropology > 360 Social problems & social services 600 Technology > 610 Medicine & health |
| Institute / Center: | 04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine |
| Depositing User: | Hammer Igor |
| Date Deposited: | 11 Sep 2025 14:04 |
| Last Modified: | 11 Sep 2025 22:25 |
| URI: | https://boristheses.unibe.ch/id/eprint/6680 |
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