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Engels EA, Shiels MS, Barnabas RV, Bohlius J, Brennan P, Castilho J, Chanock SJ, Clarke MA, Coghill AE, Combes JD, Dryden-Peterson S, D'Souza G, Gopal S, Jaquet A, Lurain K, Makinson A, Martin J, Muchengeti M, Newton R, Okuku F, Orem J, Palefsky JM, Ramaswami R, Robbins HA, Sigel K, Silver S, Suneja G, Yarchoan R, Clifford GM. State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI. Int J Cancer 2024; 154:596-606. [PMID: 37715370 PMCID: PMC11133517 DOI: 10.1002/ijc.34727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 09/17/2023]
Abstract
An estimated 38 million people live with human immunodeficiency virus (HIV) worldwide and are at excess risk for multiple cancer types. Elevated cancer risks in people living with HIV (PLWH) are driven primarily by increased exposure to carcinogens, most notably oncogenic viruses acquired through shared transmission routes, plus acceleration of viral carcinogenesis by HIV-related immunosuppression. In the era of widespread antiretroviral therapy (ART), life expectancy of PLWH has increased, with cancer now a leading cause of co-morbidity and death. Furthermore, the types of cancers occurring among PLWH are shifting over time and vary in their relative burden in different parts of the world. In this context, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) convened a meeting in September 2022 of multinational and multidisciplinary experts to focus on cancer in PLWH. This report summarizes the proceedings, including a review of the state of the science of cancer descriptive epidemiology, etiology, molecular tumor characterization, primary and secondary prevention, treatment disparities and survival in PLWH around the world. A consensus of key research priorities and recommendations in these domains is also presented.
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Affiliation(s)
- Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Bohlius
- University of Basel, Basel, Switzerland
- Department for Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Jessica Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Anna E Coghill
- Department of Cancer Epidemiology and Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jean-Damien Combes
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
| | - Scott Dryden-Peterson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Antoine Jaquet
- National Institute for Health and Medical Research (INSERM), UMR, 1219, Research Institute for Sustainable Development (IRD), EMR 271, Bordeaux Population, Health Centre, University of Bordeaux, Bordeaux, France
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alain Makinson
- Infectious Disease Department, CHU La Colombière, Montpellier & Inserm U1175, University of Montpellier, Montpellier, France
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, York, UK
| | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
| | | | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gary M Clifford
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections Branch, Lyon, France
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Davidović M, Asangbeh SL, Taghavi K, Dhokotera T, Jaquet A, Musick B, Van Schalkwyk C, Schwappach D, Rohner E, Murenzi G, Wools-Kaloustian K, Anastos K, Omenge OE, Boni SP, Duda SN, von Groote P, Bohlius J. Facility-Based Indicators to Manage and Scale Up Cervical Cancer Prevention and Care Services for Women Living With HIV in Sub-Saharan Africa: a Three-Round Online Delphi Consensus Method. J Acquir Immune Defic Syndr 2024; 95:170-178. [PMID: 38211958 PMCID: PMC10794028 DOI: 10.1097/qai.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics. METHODS We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3). RESULTS We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2). CONCLUSION We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade.
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Grants
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 NIDDK NIH HHS
- U01 AI096299 NIAID NIH HHS
- U01 AI069923 NIAID NIH HHS
- R24 AI124872 NIAID NIH HHS
- U01 AI069911 NIAID NIH HHS
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 FIC NIH HHS
- U01 AI069919 NIAID NIH HHS
- U01 AI069907 NIAID NIH HHS
- U01 AI069924 NIAID NIH HHS
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 NHLBI NIH HHS
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 NIMH NIH HHS
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 NIDA NIH HHS
- U01 AI069918 NIAID NIH HHS
- Central Africa, U01AI096299; East Africa, U01AI069911; Southern Africa, U01AI069924; West Africa, U01AI069919 NIAAA NIH HHS
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Affiliation(s)
- Maša Davidović
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Serra Lem Asangbeh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tafadzwa Dhokotera
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM), UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN
| | - Cari Van Schalkwyk
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - David Schwappach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda) and Rwanda Military Hospital, Kigali, Rwanda
| | | | - Kathryn Anastos
- Departments of Medicine and Epidemiology, Albert Einstein College of Medicine, Bronx, NY
| | | | - Simon Pierre Boni
- Programme PAC-CI, Abidjan, Côte d'Ivoire
- National Cancer Control Program, Côte d'Ivoire; and
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Per von Groote
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Julia Bohlius
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Effah K, Anthony R, Tekpor E, Amuah JE, Wormenor CM, Tay G, Kraa SEY, Katso AM, Akonnor CA, Kemawor S, Danyo S, Atuguba BH, Essel NOM, Akakpo PK. HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening. Cancer Control 2024; 31:10732748241244678. [PMID: 38563112 PMCID: PMC10989037 DOI: 10.1177/10732748241244678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV. OBJECTIVES This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana. METHODS Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana. RESULTS Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive). CONCLUSIONS There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.
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Affiliation(s)
- Kofi Effah
- Catholic Hospital, Battor, Volta Region, Ghana
| | | | | | - Joseph E. Amuah
- Catholic Hospital, Battor, Volta Region, Ghana
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | | | | | | | | | - Nana Owusu M. Essel
- Catholic Hospital, Battor, Volta Region, Ghana
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Patrick K. Akakpo
- Department of Pathology, School of Medical Sciences, Clinical Teaching Center, University of Cape Coast, Cape Coast, Ghana
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Chipanta D, Kapambwe S, Nyondo-Mipando AL, Pascoe M, Amo-Agyei S, Bohlius J, Estill J, Keiser O. Socioeconomic inequalities in cervical precancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe: analysis of Population-Based HIV Impact Assessment surveys. BMJ Open 2023; 13:e067948. [PMID: 37339830 PMCID: PMC10314495 DOI: 10.1136/bmjopen-2022-067948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES We examined age, residence, education and wealth inequalities and their combinations on cervical precancer screening probabilities for women. We hypothesised that inequalities in screening favoured women who were older, lived in urban areas, were more educated and wealthier. DESIGN Cross-sectional study using Population-Based HIV Impact Assessment data. SETTING Ethiopia, Malawi, Rwanda, Tanzania, Zambia and Zimbabwe. Differences in screening rates were analysed using multivariable logistic regressions, controlling for age, residence, education and wealth. Inequalities in screening probability were estimated using marginal effects models. PARTICIPANTS Women aged 25-49 years, reporting screening. OUTCOME MEASURES Self-reported screening rates, and their inequalities in percentage points, with differences of 20%+ defined as high inequality, 5%-20% as medium, 0%-5% as low. RESULTS The sample size of participants ranged from 5882 in Ethiopia to 9186 in Tanzania. The screening rates were low in the surveyed countries, ranging from 3.5% (95% CI 3.1% to 4.0%) in Rwanda to 17.1% (95% CI 15.8% to 18.5%) and 17.4% (95% CI 16.1% to 18.8%) in Zambia and Zimbabwe. Inequalities in screening rates were low based on covariates. Combining the inequalities led to significant inequalities in screening probabilities between women living in rural areas aged 25-34 years, with a primary education level, from the lowest wealth quintile, and women living in urban areas aged 35-49 years, with the highest education level, from the highest wealth quintile, ranging from 4.4% in Rwanda to 44.6% in Zimbabwe. CONCLUSIONS Cervical precancer screening rates were inequitable and low. No country surveyed achieved one-third of the WHO's target of screening 70% of eligible women by 2030. Combining inequalities led to high inequalities, preventing women who were younger, lived in rural areas, were uneducated, and from the lowest wealth quintile from screening. Governments should include and monitor equity in their cervical precancer screening programmes.
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Affiliation(s)
- David Chipanta
- ERA, UNAIDS, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | | | | | | | - Silas Amo-Agyei
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Julia Bohlius
- Swiss Tropical and Public Health Institute, University of Bern, Basel, Switzerland
| | - Janne Estill
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Olivia Keiser
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
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Ng'ambi W, Zyambo C. Cervical cancer care cascade among women living with human immunodeficiency virus in 13 sub-Saharan Africa countries between 2019 and 2021: An ecological analysis of PEPFAR Panorama cervical cancer program data. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2023. [DOI: 10.4103/jncd.jncd_14_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Yang L, Boily MC, Rönn MM, Obiri-Yeboah D, Morhason-Bello I, Meda N, Lompo O, Mayaud P, Pickles M, Brisson M, Hodgins C, Delany-Moretlwe S, Maheu-Giroux M. Regional and country-level trends in cervical cancer screening coverage in sub-Saharan Africa: A systematic analysis of population-based surveys (2000-2020). PLoS Med 2023; 20:e1004143. [PMID: 36634119 PMCID: PMC9882915 DOI: 10.1371/journal.pmed.1004143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/27/2023] [Accepted: 11/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest cervical cancer (CC) burden globally-worsened by its HIV epidemics. In 2020, the World Health Organization (WHO) introduced a CC elimination strategy with goals for vaccination, screening, and treatment. To benchmark progress, we examined temporal trends in screening coverage, percent screened at least twice by the age of 45, screening coverage among women living with HIV (WLHIV), and pre-cancer treatment coverage in SSA. METHODS AND FINDINGS We conducted a systematic analysis of cross-sectional population-based surveys. It included 52 surveys from 28 countries (2000 to 2020) with information on CC screening among women aged 25 to 49 years (N = 151,338 women). We estimated lifetime and past 3-year screening coverage by age, year, country, and HIV serostatus using a Bayesian multilevel model. Post-stratification and imputations were done to obtain aggregate national, regional, and SSA-level estimates. To measure re-screening by age 45, a life table model was developed. Finally, self-reported pre-cancer treatment coverage was pooled across surveys using a Bayesian meta-analysis. Overall, an estimated 14% (95% credible intervals [95% CrI]: 11% to 21%) of women aged 30 to 49 years had ever been screened for CC in 2020, with important regional and country-level differences. In Eastern and Western/Central Africa, regional screening coverages remained constant from 2000 to 2020 and WLHIV had greater odds of being screened compared to women without HIV. In Southern Africa, however, screening coverages increased and WLHIV had equal odds of screening. Notably this region was found to have higher screening coverage in comparison to other African regions. Rescreening rates were high among women who have already been screened; however, it was estimated that only 12% (95% CrI: 10% to 18%) of women had been screened twice or more by age 45 in 2020. Finally, treatment coverage among 4 countries with data was 84% (95% CrI: 70% to 95%). Limitations of our analyses include the paucity of data on screening modality and the few countries that had multiple surveys. CONCLUSION Overall, CC screening coverage remains sub-optimal and did not improve much over the last 2 decades, outside of Southern Africa. Action is needed to increase screening coverage if CC elimination is to be achieved.
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Affiliation(s)
- Lily Yang
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Dorcas Obiri-Yeboah
- Microbiology and Immunology Department, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Imran Morhason-Bello
- Department of Obstetrics and Gynaecology and Institute of Advanced Medical Research and Training, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Nicolas Meda
- Faculty of Medicine, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Olga Lompo
- Centre de Recherche Internationale en Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Philippe Mayaud
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Caroline Hodgins
- Department of Microbiology and Immunology, McGill University, Montréal, Québec, Canada
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Québec, Canada
- * E-mail:
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