Almost 90% of cervical cancer deaths occur in low and middle income countries. Uptake of HPV vaccination and cervical screening in these settings has lagged behind high income countries. Such interventions are needed in order to achieve UN Sustainable Development Goals on non-communicable diseases. However, the optimal combination of preventive options in such resource-limited settings needs to be carefully selected.
Mathematical models of the health and economic impact of HPV vaccination and cervical screening can be used to inform decision making about cervical cancer control. Existing models have highlighted the impact and cost-effectiveness of vaccinating girls prior to sexual debut. However, more complex options such as catch-up vaccination, gender-neutral vaccination and the selection of appropriate algorithms for screening will require models that take into account sexual behaviour, HPV epidemiology and co-morbidities (such as HIV co-infection) in these settings.
Investment is urgently needed in both data collection and mathematical modelling to inform decisions about cervical cancer prevention in low and middle income countries.