Modeling the Impact of Active HPV Testing Intervention on Cervical Cancer Burden in India

The global burden of mortality in women due to cervical cancer is relatively high in low and medium-income countries (LMIC), particularly India. The majority of cervical cancer cases are due to persistent and long-term infection with the Human papillomavirus (HPV). HPV testing plays a crucial role in identifying women with HPV infections at an early stage, before progression to cervical cancer, enabling timely intervention. This helps in reducing the cervical cancer burden in LMIC, in addition to vaccination and screening. However, there are no systematic modelling studies to investigate the role of HPV testing in cervical cancer burden. This work develops a mathematical model to investigate the impact of active HPV testing in reducing HPV infections and cervical cancer burden in India. By introducing an HPV infected compartment using HPV testing, our model captures the dynamics of known infected and unknown infected individuals, tracking infection progression, recovery from HPV infection, and cancer outcomes (cancerous cases, cancer mortality, cancer survival). The parameters in the proposed model are calibrated using the literature and epidemiological data specific to the Indian context. The simulation studies involving different testing population ages and HPV testing coverage rates are performed to understand the impact of active testing. The results from these studies indicate that higher testing rates can reduce the prevalence of cervical cancer and overall mortality. Furthermore, an optimal control approach with the active HPV testing coverage as a decision variable is employed to derive cost-effective strategies for minimizing treatment and HPV testing expenses. These findings highlight the necessity of appropriate resource allocation and policy interventions to curb the prevalence of HPV and mitigate the global burden of cervical cancer in India.