Project CN001: Cervical Cancer Prevention Clinical Services Utilization Mapping Initiative

A Preliminary Analysis

Author

Lu Mao (CNCC)

Published

August 13, 2026

1 Overview

Project CN001 is a CASCADE network-wide initiative aimed at evaluating clinical service utilization and outcomes of cervical cancer prevention programs among Women Living with HIV (WLWH) at participating CASCADE Clinical Sites (CSs).

As of 2026-08-12, Project CN001 has enrolled n=23486 WLWH across multiple CASCADE Clinical Sites.

Table 1: Current enrollment totals by site and clinic
Clinical Site N
CS2 – Kenya (Coptic Hope Center) 1835
CS3 - Botswana 425
CS4 – Georgia, US (Emory) 730
CS6 – Kenya (KEMRI / JKUAT) 1018
CS7 – Zimbabwe 18457
CS8 - Maryland, US 681
CS9 – South Africa (CAPRISA) 340
Total 23486
Figure 1: Cumulative enrollment by site over HX visit date

All analyses are restricted to n=23314 HIV positive participants.

2 HX - Clinical History

Table 2: Summary of key variables from HX instrument
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 1,8351		 CS3 - Botswana
N = 4201		 CS4 – Georgia, US (Emory)
N = 7251		 CS6 – Kenya (KEMRI / JKUAT)
N = 1,0121		 CS7 – Zimbabwe
N = 18,3051		 CS8 - Maryland, US
N = 6781		 CS9 – South Africa (CAPRISA)
N = 3401		 Overall
N = 23,3151
hx_age 41 (34, 45) 50 (43, 58) 51 (39, 59) 45 (36, 52) 40 (34, 44) 53 (40, 61) 37 (32, 42) 40 (34, 45)
    Unknown 0 0 0 0 1 0 0 1
Meets CN001 eligibility 1,834 (100%) 420 (100%) 723 (100%) 1,008 (100%) 18,231 (100%) 678 (100%) 338 (99%) 23,232 (100%)
    Unknown 0 0 0 0 9 0 0 9
Prior cervical screening 1,392 (78%) 245 (77%) 721 (99%) 607 (60%) 16,004 (88%) 650 (96%) 196 (58%) 19,815 (86%)
    Unknown 39 103 0 2 26 0 1 171
Result of last screening







    Normal 1,328 (98%) 214 (94%) 480 (68%) 517 (92%) 15,576 (98%) 423 (67%) 135 (69%) 18,673 (95%)
    Abnormal 34 (2.5%) 14 (6.1%) 230 (32%) 47 (8.3%) 365 (2.3%) 205 (33%) 60 (31%) 955 (4.9%)
    Unknown 473 192 15 448 2,364 50 145 3,687
Prior cervical precancer 38 (2.1%) 0 (NA%) 276 (38%) 39 (3.9%) 1,415 (7.8%) 65 (9.6%) 23 (6.8%) 1,856 (8.2%)
    Unknown 32 420 1 2 117 0 3 575
Prior precancer treatment 24 (65%) 0 (NA%) 120 (44%) 25 (66%) 644 (46%) 53 (91%) 3 (14%) 869 (47%)
    Unknown 1,798 420 450 974 16,901 620 318 21,481
Currently pregnant 1 (<0.1%) 0 (NA%) 19 (2.6%) 15 (1.5%) 57 (0.3%) 5 (0.7%) 3 (0.9%) 100 (0.4%)
    Unknown 3 420 4 3 60 0 1 491
History of hysterectomy 2 (0.1%) 0 (NA%) 72 (12%) 22 (2.2%) 6 (<0.1%) 8 (1.2%) 0 (0%) 110 (0.5%)
    Unknown 1 420 147 3 93 0 2 666
Year of HIV diagnosis known 1,771 (97%) 0 (NA%) 508 (70%) 994 (98%) 18,097 (99%) 492 (73%) 337 (99%) 22,199 (97%)
    Unknown 0 420 0 0 0 0 0 420
hx_year_hiv_diag 2,015.0 (2,009.0, 2,020.0) NA (NA, NA) 2,009.0 (2,001.0, 2,016.0) 2,013.0 (2,009.0, 2,019.0) 2,017.0 (2,014.0, 2,021.0) 2,007.0 (1,998.5, 2,013.0) 2,014.0 (2,010.0, 2,018.0) 2,017.0 (2,013.0, 2,021.0)
    Unknown 64 420 217 18 247 186 3 1,155
1 Median (Q1, Q3); n (%)

3 HI - HIV RNA Viral Load

Figure 2: HIV RNA detection reported by HI (viral load number available for those with RNA detected)
Table 3: HIV RNA detection status by site (at first visit reported in HI instrument)
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 1,8321		 CS4 – Georgia, US (Emory)
N = 7241		 CS6 – Kenya (KEMRI / JKUAT)
N = 9571		 CS7 – Zimbabwe
N = 17,5881		 CS9 – South Africa (CAPRISA)
N = 3081
HIV RNA Detected 331 (19%) 164 (23%) 141 (15%) 1,182 (6.8%) 100 (33%)
    Unknown 106 0 1 94 3
1 n (%)
Table 4: HIV RNA viral load (copies/mL) among those with detected RNA, by site
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 3311		 CS4 – Georgia, US (Emory)
N = 1641		 CS6 – Kenya (KEMRI / JKUAT)
N = 1411		 CS7 – Zimbabwe
N = 1,1821		 CS9 – South Africa (CAPRISA)
N = 1001
HIV RNA Viral Load (copies/mL) 29 (20, 81) 47 (20, 1,300) 96 (44, 696) 30 (20, 40) 50 (22, 128)
1 Median (Q1, Q3)
Figure 3: Boxplot of HIV RNA viral load (copies/mL) among those with detected RNA, by site

Set

  • Viral load \(=0\) if RNA not detected
Table 5: HIV RNA viral load (log(1 + copies/mL), VL=0 if not detected) by site
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 1,8321		 CS4 – Georgia, US (Emory)
N = 7241		 CS6 – Kenya (KEMRI / JKUAT)
N = 9571		 CS7 – Zimbabwe
N = 17,5881		 CS9 – South Africa (CAPRISA)
N = 3081
HIV RNA Viral Load (log(1 + copies/mL), VL=0 if not detected) 0.35 (0.80) 0.51 (1.09) 0.36 (0.96) 0.11 (0.44) 0.64 (1.02)
    Unknown 106 0 1 94 3
1 Mean (SD)

4 CD - CD4 Value

Figure 4: Participant count reported by CD (with CD4 count measured)
Figure 5: CD4 measurement status (1st report) by HIV RNA detection status and site
Table 6: CD4 count (cells/µL) among those with CD4 measured (at first report) by site and HIV RNA detection status
Characteristic
CS2 – Kenya (Coptic Hope Center)
CS4 – Georgia, US (Emory)
CS6 – Kenya (KEMRI / JKUAT)
CS7 – Zimbabwe
CS8 - Maryland, US
CS9 – South Africa (CAPRISA)
Yes
N = 2631		 No
N = 1,0381		 Unknown
N = 281		 Yes
N = 1641		 No
N = 5601		 Unknown
N = 01		 Yes
N = 821		 No
N = 4211		 Unknown
N = 131		 Yes
N = 141		 No
N = 891		 Unknown
N = 2281		 Yes
N = 01		 No
N = 01		 Unknown
N = 6661		 Yes
N = 881		 No
N = 1591		 Unknown
N = 41
CD4 count (cells/µL) 392 (244, 586) 478 (286, 671) 361 (294, 406) 470 (191, 710) 679 (474, 990) NA (NA, NA) 433 (301, 593) 465 (310, 669) 200 (131, 450) 250 (179, 421) 200 (200, 320) 200 (200, 250) NA (NA, NA) NA (NA, NA) 728 (468, 1,041) 531 (351, 778) 645 (430, 860) 943 (557, 1,317)
1 Median (Q1, Q3)
Figure 6: Boxplot of CD4 count (cells/µL) among those with CD4 measured (at first report) by site and HIV RNA detection status

5 AT - ART Regimen

Figure 7: Participant count by number of ART regimen started

6 SC - Screening Visit

Figure 8: Screening modalities performed by SC visit

6.1 Overall Screening by Site

Figure 9: Screening modalities performed at first SC visit, by site
Table 7: Screening modality combinations performed at first SC visit, by site
Characteristic
CS2 – Kenya (Coptic Hope Center)
CS4 – Georgia, US (Emory)
CS6 – Kenya (KEMRI / JKUAT)
CS7 – Zimbabwe
CS8 - Maryland, US
N = 1,7771 N = 7201 N = 1001 N = 17,9721 N = 6311
Screening Modality Combination




    HPV only 125 (7.0%) 16 (2.2%) 54 (54%) 1,031 (5.7%) 2 (0.3%)
    Cytology only 2 (0.1%) 50 (6.9%) 0 (0%) 0 (0%) 202 (32%)
    Dual Stain only 0 (0%) 0 (0%) 0 (0%) 1 (<0.1%) 0 (0%)
    VIA only 1,637 (92%) 0 (0%) 45 (45%) 14,576 (81%) 0 (0%)
    AI only 0 (0%) 0 (0%) 0 (0%) 1 (<0.1%) 0 (0%)
    HPV + Cytology 1 (<0.1%) 654 (91%) 1 (1.0%) 0 (0%) 427 (68%)
    HPV + VIA 12 (0.7%) 0 (0%) 0 (0%) 2,355 (13%) 0 (0%)
    Other 0 (0%) 0 (0%) 0 (0%) 8 (<0.1%) 0 (0%)
1 n (%)

6.2 VIA

Table 8: VIA test results at first SC visit, among those with VIA performed, by site
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 1,6491		 CS6 – Kenya (KEMRI / JKUAT)
N = 451		 CS7 – Zimbabwe
N = 16,9391
VIA Test Results


    Negative 1,558 (94%) 41 (91%) 16,310 (96%)
    Positive 84 (5.1%) 4 (8.9%) 566 (3.3%)
    Suspiciousforcancer 4 (0.2%) 0 (0%) 38 (0.2%)
    Other 3 (0.2%) 0 (0%) 24 (0.1%)
    Unknown 0 0 1
1 n (%)
Table 9: Treatment and referral among those with non-negative VIA results at first SC visit, by site
Characteristic
CS2 – Kenya (Coptic Hope Center)
CS6 – Kenya (KEMRI / JKUAT)
CS7 – Zimbabwe
Other
N = 31		 Positive
N = 841		 Suspiciousforcancer
N = 41		 Positive
N = 41		 Other
N = 241		 Positive
N = 5661		 Suspiciousforcancer
N = 381
Patient treated at visit






    No 3 (100%) 35 (42%) 4 (100%) 1 (25%) 20 (83%) 260 (46%) 32 (84%)
    Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 3 (0.5%) 1 (2.6%)
    Yes 0 (0%) 49 (58%) 0 (0%) 3 (75%) 4 (17%) 303 (54%) 5 (13%)
Type of treatment provided at visit






    Thermal ablation 0 (NA%) 49 (100%) 0 (NA%) 3 (100%) 0 (0%) 251 (83%) 0 (0%)
    Cryotherapy 0 (NA%) 0 (0%) 0 (NA%) 0 (0%) 0 (0%) 2 (0.7%) 0 (0%)
    LEEP/LLETZ 0 (NA%) 0 (0%) 0 (NA%) 0 (0%) 0 (0%) 46 (15%) 0 (0%)
    Other 0 (NA%) 0 (0%) 0 (NA%) 0 (0%) 4 (100%) 4 (1.3%) 4 (80%)
    Unknown 0 (NA%) 0 (0%) 0 (NA%) 0 (0%) 0 (0%) 0 (0%) 1 (20%)
Referred for evaluation






    No 3 (100%) 49 (58%) 0 (0%) 3 (75%) 19 (79%) 463 (82%) 27 (71%)
    Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (8.3%) 4 (0.7%) 0 (0%)
    Yes 0 (0%) 35 (42%) 4 (100%) 1 (25%) 3 (13%) 98 (17%) 11 (29%)
Referred for treatment






    No 2 (67%) 58 (69%) 1 (25%) 3 (75%) 21 (88%) 372 (66%) 15 (39%)
    Unknown 0 (0%) 2 (2.4%) 0 (0%) 0 (0%) 0 (0%) 4 (0.7%) 0 (0%)
    Yes 1 (33%) 24 (29%) 3 (75%) 1 (25%) 3 (13%) 190 (34%) 23 (61%)
1 n (%)

6.3 HPV

Table 10: HPV test results at first SC visit, among those with HPV testing performed, by site
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 1381		 CS4 – Georgia, US (Emory)
N = 6701		 CS6 – Kenya (KEMRI / JKUAT)
N = 551		 CS7 – Zimbabwe
N = 3,3861		 CS8 - Maryland, US
N = 4291
HPV Test Assay




    AbbottAlinity 137 (99%) 0 (0%) 0 (0%) 24 (0.7%) 0 (NA%)
    XpertHPV 1 (0.7%) 0 (0%) 21 (38%) 1,047 (31%) 0 (NA%)
    Other 0 (0%) 667 (100%) 34 (62%) 2,216 (66%) 0 (NA%)
    Unknown 0 (0%) 3 (0.4%) 0 (0%) 94 (2.8%) 0 (NA%)
    Unknown 0 0 0 5 429
HPV test results




    Negative 105 (76%) 521 (78%) 9 (16%) 876 (26%) 303 (71%)
    Positive 33 (24%) 140 (21%) 11 (20%) 528 (16%) 102 (24%)
    Other/Unknown 0 (0%) 9 (1.3%) 35 (64%) 1,982 (59%) 24 (5.6%)
1 n (%)
Table 11: HPV test assay at first SC visit, among those with HPV testing performed, by site
Characteristic
CS2 – Kenya (Coptic Hope Center)
CS4 – Georgia, US (Emory)
CS6 – Kenya (KEMRI / JKUAT)
CS7 – Zimbabwe
CS8 - Maryland, US
Positive
N = 331		 Positive
N = 1401		 Other/Unknown
N = 91		 Positive
N = 111		 Other/Unknown
N = 351		 Positive
N = 5281		 Other/Unknown
N = 1,9821		 Positive
N = 1021		 Other/Unknown
N = 241
Patient treated at visit








    No 17 (94%) 139 (99%) 7 (100%) 11 (100%) 35 (100%) 496 (94%) 1,935 (98%) 102 (100%) 24 (100%)
    Yes 1 (5.6%) 1 (0.7%) 0 (0%) 0 (0%) 0 (0%) 30 (5.7%) 42 (2.1%) 0 (0%) 0 (0%)
Type of treatment provided at visit








    LEEPLLETZ 0 (0%) 1 (100%) 0 (NA%) 0 (NA%) 0 (NA%) 5 (17%) 8 (19%) 0 (NA%) 0 (NA%)
    Other 0 (0%) 0 (0%) 0 (NA%) 0 (NA%) 0 (NA%) 3 (10%) 3 (7.1%) 0 (NA%) 0 (NA%)
    Thermalablation 1 (100%) 0 (0%) 0 (NA%) 0 (NA%) 0 (NA%) 22 (73%) 31 (74%) 0 (NA%) 0 (NA%)
Referred for evaluation








    No 15 (79%) 42 (30%) 4 (57%) 10 (91%) 35 (100%) 510 (97%) 1,955 (99%) 30 (33%) 3 (18%)
    Yes 4 (21%) 96 (70%) 3 (43%) 1 (9.1%) 0 (0%) 16 (3.0%) 14 (0.7%) 60 (67%) 14 (82%)
Referred for treatment








    No 19 (100%) 121 (88%) 7 (100%) 10 (91%) 35 (100%) 490 (94%) 1,950 (99%) 100 (99%) 23 (100%)
    Yes 0 (0%) 17 (12%) 0 (0%) 1 (9.1%) 0 (0%) 34 (6.5%) 27 (1.4%) 1 (1.0%) 0 (0%)
1 n (%)

6.4 Cytology

Table 12: Cytology test results at first SC visit, among those with Cytology testing performed, by site
Characteristic CS2 – Kenya (Coptic Hope Center)
N = 31		 CS4 – Georgia, US (Emory)
N = 7041		 CS6 – Kenya (KEMRI / JKUAT)
N = 11		 CS8 - Maryland, US
N = 6291
Cytology Test Results



    NILM 3 (100%) 473 (67%) 1 (100%) 473 (75%)
    HSILCIN 0 (0%) 5 (0.7%) 0 (0%) 0 (0%)
    ASCUS 0 (0%) 104 (15%) 0 (0%) 66 (10%)
    LSILCIN1 0 (0%) 75 (11%) 0 (0%) 64 (10%)
    ASCH 0 (0%) 11 (1.6%) 0 (0%) 1 (0.2%)
    HSILCIN2 0 (0%) 2 (0.3%) 0 (0%) 0 (0%)
    HSILNotspecified 0 (0%) 5 (0.7%) 0 (0%) 0 (0%)
    Unknown 0 (0%) 6 (0.9%) 0 (0%) 0 (0%)
    HSILCIN2CIN3 0 (0%) 0 (0%) 0 (0%) 10 (1.6%)
    Other 0 (0%) 23 (3.3%) 0 (0%) 15 (2.4%)
1 n (%)
Table 13: Treatment and referral among those with abnormal Cytology results at first SC visit, by site
Characteristic
CS4 – Georgia, US (Emory)
CS8 - Maryland, US
Non-NILM
N = 2081		 Other
N = 231		 Non-NILM
N = 1411		 Other
N = 151
Patient treated at visit 2 (1.0%) 0 (0%) 0 (0%) 0 (0%)
Type of treatment provided at visit



    LEEPLLETZ 1 (50%) 0 (NA%) 0 (NA%) 0 (NA%)
    Other 1 (50%) 0 (NA%) 0 (NA%) 0 (NA%)
Referred for evaluation 127 (64%) 4 (17%) 99 (80%) 0 (0%)
Referred for treatment 20 (10%) 0 (0%) 6 (4.3%) 0 (0%)
1 n (%)