Cervical Cancer Screening with Visual Inspection with Acetic Acid (VIA) among Women Living with HIV in Nairobi, Kenya: Results and Transformation Zone

Background: Cervical cancer remains a major public health challenge among women living with HIV (WLWH) in sub-Saharan Africa, where screening coverage remains suboptimal despite opportunities for integration within HIV care programs. Visual inspection with acetic acid (VIA) has been widely used as a low-cost screening approach in resource-limited settings. Methods: This cross-sectional analysis utilized prospectively collected data from Project CN001 at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, a CASCADE Clinical Trials Network site. WLWH aged 25-49 years receiving routine HIV care and undergoing VIA screening between March 11, 2025, and January 16, 2026, were included. Data from the REDCap and Kenya's electronic medical record system (KenyaEMR) captured sociodemographic characteristics, HIV clinical factors, VIA results, and cervical transformation zone (TZ) classification. Results: Among 857 WLWH screened with VIA, the median age was 40 years (interquartile ranges [IQR]: 34-45), and 77.2% reported a prior history of cervical cancer screening. VIA positivity was 7.4% (63/857) and was higher in women with TZ1/TZ2 than in those with TZ3. VIA positivity was also associated with higher HIV viral load, shorter time since HIV diagnosis, no cervical screening history, and younger age at screening. The proportion of women classified as TZ3 increased with age, from 39.5% among women aged 25-29 years to 67.7% among those aged 45-49 years, while the proportion classified as TZ1 decreased with increasing age. Conclusion: Integrated screening at this urban U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and CASCADE-supported HIV clinic demonstrates the feasibility of integrated cervical cancer screening programs for WLWH. Age-related TZ3 predominance and VIA limitations for older women highlight the need for refined screening strategies and continued electronic platform utilization for program monitoring to support cervical cancer elimination targets.