Nicole G. Campos (United States of America)

Harvard T.H. Chan School of Public Health Health Policy and Management

Presenter of 1 Presentation

 Conference Calendar
Public Health / Epidemiology / Screening for HPV-related Disease: Implementation, Evaluation and Impact ePoster

ADAPTING HEALTH DECISION SCIENCE MODELS FOR EVALUATION OF PRIMARY HPV SCREENING (ID 1024)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Public Health / Epidemiology / Screening for HPV-related Disease: Implementation, Evaluation and Impact
Lecture Time
10:07 - 10:08
Presenter
Authors

Abstract

Introduction

Control of cervical cancer will require cost-effective strategies that can be adapted across settings. We hypothesize that the most cost-effective options for prevention are prophylactic HPV vaccination of young girls and screening with primary HPV testing (including self-collection). For HPV-positive women, triage tests— e.g., automated visual evaluation (machine learning applied to visual triage methods)— will need to minimize overtreatment while ensuring safety.

Methods

We are developing an evidence-based framework for health decision models that will be used to evaluate screening strategies across different resource settings. The natural history framework is based on a simple multi-stage causal pathway of cervical carcinogenesis: acquisition of a carcinogenic HPV infection; viral persistence; progression to precancer; and invasion. Health state transitions vary depending on the immune status of the target population, requiring at least 3 distinct natural history models: immunocompetent women (Model 1); partially immunocompromised women due to environmental conditions (e.g., chronic parasitosis) (Model 2); and women living with HIV (WLHIV) (Model 3).

Results

We will provide an update on development of the 3 natural history models. Extensive data are available to inform HPV type- and time-dependent health state transitions in Model 1, which represents populations with an initial peak HPV prevalence around sexual initiation followed by a secondary peak of precancer some years later. More longitudinal data are needed to inform transitions in Model 2, which represents populations with less of an age-related decline in HPV prevalence, likely due to reduced viral clearance. Model 3 is characterized by a lifelong loss of HPV control, requiring different strategies of screening and treatment; for WLHIV we hypothesize that programmatic success will hinge on the ability of treatment to interrupt the transition from precancer to cancer.

Conclusions

Novel screening technologies require advances in health decision models. Model development is underway.

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Moderator of 1 Session

 Conference Calendar
Public Health Oral Session

00860 - Oral Session 11: MODELLING II. Modelling and economic analyses for cervical cancer elimination (ID 48)

Session Type
Public Health Oral Session
Session Date
07/23/2020
Session Time
08:30 - 09:55
Room
Hall E
Chair(s)

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