Background:
As high-quality local data is limited, public health decision modelling tools designed to support cervical cancer prevention policies in low- and middle-income countries remain exceedingly scarce. Over time, IARC’s Public Health Decision Science (PHDS) Team has developed the METHIS modelling platform to enable projection of the impact of cervical cancer preventive measures and has collected data on HPV prevalence among young women through the CHRONOS Center of Excellence to monitor the impact of HPV vaccination.
Objectives:
To showcase the Team’s work in supporting cervical cancer prevention policies, we used data of the first two CHRONOS studies in Bhutan and Rwanda (which were also the first two LMICs to introduce HPV vaccination) and the METHIS models and to evaluate the impact of a range of local cervical cancer prevention measures.
Methods:
The METHIS models were calibrated to the HPV prevalence data of the CHRONOS baseline (pre-vaccination) and repeat (post-vaccination) surveys, on top of data on sexual behavior (from the Demographic Health Surveys) and cervical cancer incidence and mortality (from GLOBOCAN). As prevention measures for Bhutan, we evaluated the cost-effectiveness of switching from two- to single-dose HPV vaccination and the impact of a nationwide cervical cancer screen-and-treat campaign in women aged 30-65 years. For Rwanda, we evaluated the impact of a one-off HPV catch-up vaccination program in women aged 26-30 years and the additional health benefit of switching from the 4- to 9-valent vaccine.
Results:
In Bhutan, our modelling results shows that switching from single-dose vaccination is highly cost-effective. These results have directly led to the switch to single-dose vaccination in the country in April 2025. The recently implemented nationwide cervical cancer screen-and-treat campaign is expected to accelerate cervical cancer elimination, reducing the time until elimination by approximately 35 years. In Rwanda, a one-off catch-up campaign would prevent 310 additional cases of cervical cancer throughout lifetime of the targeted cohorts in the country, while the switch from the 4- to 9-valent vaccine is expected further decreased the cervical cancer incidence from 5.4 to 2 (cases per 100,000 person-years), allowing cervical cancer elimination.
Conclusions/Implications:
Using the METHIS modelling platform and collected CHRONOS data, IARC’s PHDS Team has supported public health decisions on cervical cancer prevention in a wide range of countries including Bhutan and Rwanda. It will continue to be used to support global and local stakeholders to coordinate, design, and implement impactful and efficient context-specific prevention policies and accelerate cervical cancer elimination.