Policy Brief: An Evidence-Based Roadmap for the Equitable Elimination of HPV-Related Cancers by 2035

2.1 Vaccination: Efficacy, schedules, and equity

A meta-analysis of 60 million individuals demonstrated that female vaccination leads to an 83% reduction in HPV 16/18 prevalence and significant reductions in anogenital warts and cervical precancer (CIN2+).³ The KEN SHE randomized controlled trial established the non-inferiority of a single dose of HPV vaccine in young women, showing 97.5% efficacy against persistent HPV16/18 infection at 18 months.⁴ Single-dose schedules are a game-changer for low-resource settings, reducing cost and logistical complexity. A two-dose schedule remains critical for immunocompromised individuals, including women living with HIV (WLHIV).⁵ Expanding vaccination to include boys is crucial for comprehensive HPV control and preventing cancers in males.⁶

2.2 Screening: Superior performance and innovative delivery

A pooled analysis of four European RCTs demonstrated that HPV-based screening provides a 60-70% greater protection against invasive cervical cancer compared to cytology.⁷ Meta-analyses confirm that self-sampling for HPV testing has comparable sensitivity to clinician-collection for detecting CIN2+ and significantly increases screening uptake among under-screened populations.⁸ Transitioning to primary HPV screening requires upfront investment in laboratory infrastructure and workforce training. Self-sampling must be coupled with effective triage pathways (e.g., p16/Ki-67 dual-stain cytology)⁹ and robust systems for linkage to treatment. Incorporating point-of-care HPV tests and digital health tools (e.g., mobile applications, telehealth) can further improve coverage and timeliness.^10,11

2.3 The critical imperative of focusing on WLHIV and marginalized groups

A global meta-analysis quantified a six-fold higher risk of cervical cancer among WLHIV compared to HIV-negative women.⁵ Marginalized groups, including rural populations and those of low socioeconomic status, consistently have lower access to services. Achieving equity requires proactive, targeted interventions, such as integrating cervical cancer screening into HIV care packages and deploying mobile units to remote areas.

2.4 Economic and political analysis

Comparative modelling in 78 low-income and lower-middle-income countries (LMICs) demonstrates that achieving the WHO 90-70-90 targets could avert 62.6 million cervical cancer deaths by 2120.¹² Vaccination and screening are highly cost-effective. This economic evidence is crucial for engaging Ministries of Finance. Investment cases should be developed at the national level to secure domestic financing and guide strategic co-investment from partners like Gavi and The Global Fund. Financing strategies should be flexible, including blended financing and innovative mechanisms.^13,14

Successful implementation requires navigating a complex stakeholder landscape. Key barriers include political (competing priorities), systemic (fragmented health systems), and social (misinformation, stigma) challenges. Mitigation strategies involve establishing a high-level, multi-sectoral task force and employing culturally sensitive community engagement strategies leveraging trusted community leaders and peer educators.^15,16

3.1 Operational roadmap: Priorities for the first three years

3.2 Monitoring, evaluation, and accountability

Priority indicators must include equity disaggregation: Vaccination coverage by socioeconomic quintile and region; Proportion of women screened, disaggregated by HIV status and geography; Proportion of screen-positive women receiving appropriate triage and treatment; Age-standardized incidence of cervical cancer. Monitoring frameworks should integrate qualitative measures to assess community perceptions and implementation fidelity.¹⁷