Cervical Cancer Screening Cascade Performance Across Three Regional Districts in Uganda, 2024–2025
Abstract
Background: Cervical cancer is the leading cause of cancer mortality among women in Uganda. This study evaluated screening positivity, diagnostic performance, and treatment cascade outcomes across three districts (2024–2025).
Methods: Retrospective analysis of 24,660 records from the Cervical Cancer Screening and Pre-Cancer Treatment Register (Kampala, Mbarara City, Mbarara District). Modalities included VIA, HPV DNA testing, and Pap smear. Analyses were stratified by district, age, and HIV status.
Results: Of 24,660 women enrolled, 44.9% were from Kampala, 31.6% Mbarara City, and 20.7% Mbarara District. Among initial screeners (n = 14,665), positivity was 12.9%; overall positivity across 23,435 screened women was 13.9% (3,252/23,435). Positivity varied by district (Kampala 14.8%, Mbarara City 11.2%, Mbarara District 11.6%), rose with age (6.5% under 25 to 17.6% aged 50+), and was higher among HIV-positive women (23.1% vs. 10.3%). HPV DNA testing had higher positivity than VIA or Pap smear (25.0% vs. 11.0%); 74.3% of HPV-positive women were also VIA-positive. Invasive cancer was found in 4.3% of screen-positive women (140/3,252), rising to 20.9% in those aged 50+. HIV-positive women accounted for 42 of 140 invasive cases. Approximately 30% of screen-positive women were untreated overall; the gap was highest among first-time screeners (∼40%).
Conclusions: A critical treatment gap persists. Women living with HIV, women aged 40+, and first-time screeners require targeted interventions to improve linkage to treatment and reduce cervical cancer mortality in Uganda.
Key messages: • Despite scale-up, 30% of screen-positive women in Uganda were not treated, rising to 40% among first-time screeners — revealing a critical gap between screening and care.
• HIV-positive women and those aged 50+ bear the highest cervical cancer burden. Targeted interventions are urgently needed to close the treatment gap and save lives in Uganda.
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BibTeX
@article{akamumpa2026cervical,
title = {{Cervical Cancer Screening Cascade Performance Across Three Regional Districts in Uganda, 2024–2025}},
author = {J Akamumpa and K Moran and B Dahye and C Mpaamani and M Origa and N N Niyonzima and A N Namuli and F M Mugabe and N E Nankya and J Orem},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1108},
url = {https://doi.org/10.1093/eurpub/ckag169.1108},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cervical Cancer Screening Cascade Performance Across Three Regional Districts in Uganda, 2024–2025
AU - J Akamumpa
AU - K Moran
AU - B Dahye
AU - C Mpaamani
AU - M Origa
AU - N N Niyonzima
AU - A N Namuli
AU - F M Mugabe
AU - N E Nankya
AU - J Orem
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1108
UR - https://doi.org/10.1093/eurpub/ckag169.1108
AB - Background: Cervical cancer is the leading cause of cancer mortality among women in Uganda. This study evaluated screening positivity, diagnostic performance, and treatment cascade outcomes across three districts (2024–2025). Methods: Retrospective analysis of 24,660 records from the Cervical Cancer Screening and Pre-Cancer Treatment Register (Kampala, Mbarara City, Mbarara District). Modalities included VIA, HPV DNA testing, and Pap smear. Analyses were stratified by district, age, and HIV status. Results: Of 24,660 women enrolled, 44.9% were from Kampala, 31.6% Mbarara City, and 20.7% Mbarara District. Among initial screeners (n = 14,665), positivity was 12.9%; overall positivity across 23,435 screened women was 13.9% (3,252/23,435). Positivity varied by district (Kampala 14.8%, Mbarara City 11.2%, Mbarara District 11.6%), rose with age (6.5% under 25 to 17.6% aged 50+), and was higher among HIV-positive women (23.1% vs. 10.3%). HPV DNA testing had higher positivity than VIA or Pap smear (25.0% vs. 11.0%); 74.3% of HPV-positive women were also VIA-positive. Invasive cancer was found in 4.3% of screen-positive women (140/3,252), rising to 20.9% in those aged 50+. HIV-positive women accounted for 42 of 140 invasive cases. Approximately 30% of screen-positive women were untreated overall; the gap was highest among first-time screeners (∼40%). Conclusions: A critical treatment gap persists. Women living with HIV, women aged 40+, and first-time screeners require targeted interventions to improve linkage to treatment and reduce cervical cancer mortality in Uganda. Key messages: • Despite scale-up, 30% of screen-positive women in Uganda were not treated, rising to 40% among first-time screeners — revealing a critical gap between screening and care. • HIV-positive women and those aged 50+ bear the highest cervical cancer burden. Targeted interventions are urgently needed to close the treatment gap and save lives in Uganda.
SN - 1101-1262
SN - 1464-360X
ER -