Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies.

INTRODUCTION Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence. METHODS We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1st 2010 and March 31st 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV. RESULTS We reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%). CONCLUSION Considerable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities

Impacts of a Peer-Group Intervention on HIV-Related Knowledge, Attitudes, and Personal Behaviors for Urban Hospital Workers in Malawi

We construct and solve a classical percolation model with a phase transition that we argue acts as a proxy for the quantum many-body localization transition. The classical model is defined on a graph in the Fock space of a disordered, interacting quantum spin chain, using a convenient choice of basis. Edges of the graph represent matrix elements of the spin Hamiltonian between pairs of basis states that are expected to hybridize strongly. At weak disorder, all nodes are connected, forming a single cluster. Many separate clusters appear above a critical disorder strength, each typically having a size that is exponentially large in the number of spins but a vanishing fraction of the Fock-space dimension. We formulate a transfer matrix approach that yields an exact value ν = 2 for the localization length exponent, and also use complete enumeration of clusters to study the transition numerically in finite-sized systems

Seismic Evidence for Plume‐ and Craton‐Influenced Upper Mantle Structure Beneath the Northern Malawi Rift and the Rungwe Volcanic Province, East Africa

Abstract P and S wave tomographic models have been developed for the northern Malawi rift and adjacent Rungwe Volcanic Province (RVP) using data from the Study of Extension and maGmatism in Malawi aNd Tanzania project and data from previous networks in the study area. The main features of the models are a low‐velocity zone (LVZ) with δVp = ~−1.5–2.0% and δVs = ~−2–3% centered beneath the RVP, a lower‐amplitude LVZ (δVp = ~−1.0–1.3% and δVs = ~−0.7–1%) to the southeast of the RVP beneath the center and northeastern side of the northern Malawi rift, a shift of the lower‐amplitude anomaly at ~−10° to −11° to the west beneath the central basin and to the western side of the rift, and a fast anomaly at all depths beneath the Bangweulu Craton. The LVZ widens further at depths >~150–200 km and extends to the north beneath northwestern Malawi, wrapping around the fast anomaly beneath the craton. We attribute the LVZ beneath the RVP and the northern Malawi rift to the flow of warm, superplume mantle from the southwest, upwelling beneath and around the Bangweulu Craton lithosphere, consistent with high 3He/4He values from the RVP. The LVZ under the RVP and northern Malawi rift strongly indicates that the rifted lithosphere has been thermally perturbed. Given that volcanism in the RVP began about 10 million years earlier than the rift faulting, thermal and/or magmatic weakening of the lithosphere may have begun prior to the onset of rifting

Crustal structure and dynamics of Botswana

We present the first nationwide crustal thickness and Vp/Vs maps for Botswana based on the analysis of new P wave receiver functions of NARS‐Botswana network integrated with previous receiver function results in Botswana. Using H‐K analysis, we found crustal thickness values ranging from 34 km for the Okavango Rift Zone to 49 km at the border between the Magondi Belt and the Zimbabwe Craton. For stations with significant sediment cover, a sediment correction was applied based on sequential H‐K stacking. We observed distinct differences for the Kaapvaal craton. The eastern part has a high Vp/Vs ratio typical of a predominantly mafic composition, suggesting lateral extension of the Bushveld mafic complex. On the other hand, the western part with a Vp/Vs ratio of 1.67 is felsic, probably as a result of delamination caused by Proterozoic rifting processes. Further to the west of the Kaapvaal Craton, we found a crustal thickness of 42 km and a Vp/Vs ratio of 1.76 for the Nosop Basin. These values are similar to other cratonic regions in Botswana, suggesting the presence of a buried craton as proposed by previous studies. We confirm a relatively thin crust (∼34–39 km), compared to the rest of Botswana, and high Vp/Vs ratio (∼1.84) underneath the Okavango Rift Zone found by previous receiver function studies. Notably, we also found a relatively thin crust (37 km) and high Vp/Vs ratio (1.84) in central Botswana underneath the Passarge Basin