{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T21:55:28Z","timestamp":1769810128624,"version":"3.49.0"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research (ICMR) New Delhi","doi-asserted-by":"crossref","award":["E-Office-170995"],"award-info":[{"award-number":["E-Office-170995"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research (ICMR) New Delhi","doi-asserted-by":"crossref","award":["VIR\/Intra\/24\/2023\/CD"],"award-info":[{"award-number":["VIR\/Intra\/24\/2023\/CD"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Women living with HIV (WLHIV) face a higher risk of developing cervical cancer. India carries a significant burden of HIV, with an estimated 2.5\u2009million people living with HIV in 2023. While the introduction of more effective antiretroviral therapy has improved the life expectancy of WLHIV, it has also extended the risk window for persistent human papillomavirus (HPV) infection and cervical disease progression. Cervical cancer prevention through HPV vaccination and regular screening remains the cornerstone of public health efforts. This study specifically aims to evaluate the cost-effectiveness of various cervical cancer screening strategies (at different intervals) among WLHIV in India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The study will be conducted in three interlinked components. First, a meta-analysis will be undertaken to evaluate the diagnostic accuracy of different screening strategies in detecting cervical lesions in WLHIV. Second, primary data collection will be carried out to estimate the treatment costs of cervical cancer and HIV among WLHIV. This phase will also include the collection of health-related quality of life (HRQoL) data, to inform utility estimates for the modelling component. A total of 135 participants will be enrolled for cost data assessment. Of these, a subset of 71 participants will also be included for HRQoL assessment. This data collection will be undertaken in four tertiary public sector hospitals located across four Indian states, that is, Mizoram, Maharashtra, Tamil Nadu and Karnataka. Lastly, a decision analytical model will be developed to simulate the process of screening, diagnosis and treatment for cervical cancer in a hypothetical cohort of WLHIV. A structured comprehensive review of literature will be undertaken to inform model input parameters related to the natural history of cervical disease, progression and mortality among WLHIV. Model calibration will be performed using a likelihood-based approach to ensure consistency with empirical epidemiological data. Probabilistic sensitivity analysis will also be conducted to assess the impact of joint parameter uncertainty on model outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval has been obtained from Ethics Committees of Indian Council of Medical Research\u2013National AIDS Research Institute (NARI), Pune (Protocol No. NARI\/EC\/Approval\/2024\/716); B. J. Medical College and Sassoon General Hospitals, Pune (Ref. No. BJGMC\/IEC\/Pharmac\/ND-0824297-297); Cancer Institute (WIA), Adyar, Chennai (Ref. No. IEC\/2024\/Nov-07); the Mizoram State Cancer Institute, Zemabawk, Aizawl (Ref. No. D.12016\/2\/2013-MSCI\/IEC) and the KLE Academy of Higher Education and Research, Belagavi, Karnataka. The study findings will be disseminated through publications in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108752","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:32Z","timestamp":1769772632000},"page":"e108752","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness of cervical cancer screening among women living with HIV in India: study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0638-8661","authenticated-orcid":false,"given":"Amit Pundalik","family":"Nirmalkar","sequence":"first","affiliation":[{"name":"Disease Elimination Sciences, ICMR - National Institute of Translational Virology and AIDS Research, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9718-455X","authenticated-orcid":false,"given":"Megha","family":"Mamulwar","sequence":"additional","affiliation":[{"name":"Disease Elimination Sciences, ICMR - National Institute of Translational Virology and AIDS Research, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheela","family":"Godbole","sequence":"additional","affiliation":[{"name":"Director, ICMR - National Institute of Translational Virology and AIDS Research, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-8576","authenticated-orcid":false,"given":"Sheikh Mohammed","family":"Shahabuddin","sequence":"additional","affiliation":[{"name":"Library & Information Sciences, ICMR-National Institute of Translational Virology & AIDS Research, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2491-8372","authenticated-orcid":false,"given":"Shilpa","family":"Bembalkar","sequence":"additional","affiliation":[{"name":"Disease Elimination Sciences, ICMR - National Institute of Translational Virology and AIDS Research, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6791-2221","authenticated-orcid":false,"given":"Akashdeep Singh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003302532000_16.1.e108752.1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/QAD.0000000000001765","article-title":"HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer","volume":"32","author":"Liu","year":"2018","journal-title":"AIDS"},{"key":"2026013003302532000_16.1.e108752.2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.gore.2017.07.009","article-title":"Cervical cancer control in HIV-infected women: Past, present and future","volume":"21","author":"Ghebre","year":"2017","journal-title":"Gynecol Oncol Rep"},{"key":"2026013003302532000_16.1.e108752.3","unstructured":"World Health Organization . 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