Crossroads of care: Improving Cancer and HIV outcomes through integrated health services

As the International AIDS Society holds its HIV Science conference on 23-26 July in Brisbane, Australia, it's worth reflecting on the extraordinary strides that have been made in preventing and treating HIV, which has brought life-saving care to millions of people around the world.

With the success in addressing communicable diseases such as HIV, malaria and tuberculosis now comes the responsibility to address the rise in non-communicable diseases (NCDs), such as cancer.

In regions such as sub-Saharan Africa, deaths due to NCDs are set to surpass those due to infectious diseases by 2030. The causes are multifaceted, including urbanisation, higher life expectancy and changes in lifestyle.

In the case of cancer, a primary cause of high mortality is that people are often being diagnosed when their cancers are at an advanced stage, when the cancer is harder to treat successfully and at greater cost.

There are a number of reasons for this, one of which is a lack of the screening services that we enjoy in high-income countries that can detect cancers earlier. A striking example of this is cervical cancer: Nine out of every 10 women dying from cervical cancer live in a low- or middle-income country. This is primarily due to low vaccination rates against the human papillomavirus, which can prevent cervical cancer, and the limited screening programmes for women aged 35-45 to detect cancerous or even pre-cancerous lesions.

Integrated approaches are gaining well-deserved attention as an effective means to fill this need and ensure that people no longer die from cancers that could have been prevented or treated if detected earlier.

The idea is to take the lessons learned from addressing communicable diseases, and bring together healthcare services stakeholders and providers to deliver services for several diseases at the same time to close gaps in care. In its Framework for supporting people with HIV, the Global Fund encourages countries to integrated NCD services, adapting their healthcare services to match the specific health conditions of their population.

The benefits of integration are far-reaching, as people are often managing several diseases simultaneously – called co-morbidities – and some diseases increase the risk of developing others. This is particularly the case for those living with HIV, who are particularly vulnerable to certain types of cancers, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, head and neck cancer and cervical cancer – women living with HIV are six times more likely to develop cervical cancer.

For this reason, integrating services for cervical cancer with those deployed for HIV makes particular sense. Such an approach means training current staff and streamlining care services, such as testing a woman for HPV or examining her for cancer lesions when she comes in for HIV testing or treatment, and treating her immediately if the test is positive. Studies show that this approach is both feasible and generally well-received.

Tanzania, for example, a country facing some of the highest rates of cervical cancer in sub-Saharan Africa, developed a school-based delivery of health services for adolescents that combines HPV vaccination with nutritional assessments, eyesight check-ups and education. As some head and neck cancers (oropharyngeal) are caused by HPV infection, vaccinating boys as well as girls can also help reduce the incidence of these types of cancer.

And then there is the example of Zambia, whose Cervical Cancer Screening and Preventative Therapy (CCS&PT) programme merges family planning and cervical cancer prevention services, offering a more comprehensive set of healthcare services through mobile outreach.

The upcoming HIV Science Conference organised by the International AIDS Society is an opportune platform for dialogues on such transformative strategies.

The journey from fragmented to integrated care is more than just a healthcare strategy. It’s a bold commitment to ensure that no one is left behind in the pursuit of health.