MOAB0402 | BEYOND THE SCREEN: EVALUATING POST-TREATMENT OUTCOMES OF WOMEN LIVING WITH HIV (WLHIV) SCREENED VIAC POSITIVE IN HARARE, ZIMBABWE, 2024

Sandra Murwira¹, Michelle R Gadzayi¹, Blessing Mushangwe¹, Gloria Gonese¹, Batsirai Makunike-Chikwinya¹, Brian Moyo², Rickie Malaba², Chiedza Mapfumo³ | ¹Zimbabwe Technical Assistance, Training And Education Center For Health (Zim-TTECH), Harare, Zimbabwe; ²Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe; ³Ministry of Health and Child Care (MOHCC), Harare, Zimbabwe

Women living with HIV (WLHIV) experience elevated cervical cancer risk, requiring regular screening and timely treatment. Visual Inspection with Acetic Acid and Cervicography (VIAC) remains Zimbabwe’s main screening method, as HPV testing is not available nationwide. Since 2018, Zim-TTECH has supported cervical cancer screening for WLHIV, and in 2024, 97% of screen-positive women in Harare received treatment. National guidelines recommend re-screening at six months post-treatment follow-up (PTFU) to assess treatment success and manage recurrent lesions; however, PTFU adherence remains suboptimal. We evaluated the PTFU outcomes of WLHIVs who screened VIAC positive in 2024. A retrospective analysis was conducted at three Zim-TTECH-supported sites in Harare among WLHIV who screened VIAC-positive from January to June 2024. Eligible women were treated using ablative methods (cryotherapy/thermocoagulation) or LEEP. Six-month PTFU rescreening occurred from July to December 2024. Data on screening results, treatment methods, and six-month PTFU outcomes were extracted from program records. Univariate analysis summarized key variables; bivariate analysis (Chi-square test) assessed associations between treatment method and VIAC positivity at PTFU. Among 3,358 WLHIV screened, 239 (7.1%) were VIAC positive, including 8 with lesions suspicious of cancer. Of 231 eligible, 214 (94.7%) were treated: thermocoagulation (109), LEEP (79), and cryotherapy (26). Reasons for not being treated included lesion regression (6), refusal (5), loss to follow up (LTFU) (5), and death (1). At six-month PTFU, 154 (71.9%) screened VIAC negative, 27 (12.6%) were LTFU and hence remained at risk of lesion progression, and 23 (10.7%) remained VIAC positive, representing a combined 23.3% of treated women at risk of undetected or recurrent lesions. Among the 23 remaining positive, 13.9% had received LEEP, 11.5% thermocoagulation, and 11.5% cryotherapy. The recurrence rates are consistent with published data for WLHIV, reinforcing the need for robust PTFU systems. VIAC positivity at PTFU did not significantly differ by treatment method, χ² (1, N = 23) = 1.61, p = 0.45. Further investigation of clients who are LTFU may identify barriers to adherence with PTFU visits. In-depth review of the recurrent cases may clarify whether recurrences were adequately managed according to guidelines. Findings from these efforts may inform improvements in follow-up systems and support appropriate care for WLHIV with recurrent lesions.