Impact of the WHO's 90-70-90 Strategy on HPV-Related Cervical Cancer Control: A Mathematical Model Evaluation in China

TL;DR

This study uses a mathematical model to evaluate the impact of WHO's 90-70-90 strategy and vaccination efforts on HPV-related cervical cancer control in China, predicting elimination timelines and optimal intervention strategies.

Contribution

It develops a comprehensive compartmental model incorporating vaccination and screening, providing new insights into strategy effectiveness and optimal implementation in China.

Findings

The basic reproduction number decreased from 1.5026 to 1.0726 after vaccination.

Screening is identified as a crucial non-pharmaceutical intervention.

Zero new cervical cancer cases are predicted by 2061 with optimal strategy implementation.

Abstract

In August 2020, the World Health Assembly approved the Global Strategy to eliminate cervical cancer, marking the first time that numerous countries committed to eliminating a form of cancer. China introduced the HPV vaccine in 2016 and has made significant advancements in both prevention and treatment strategies. However, due to the relatively late introduction of the vaccine, the burden of cervical cancer in China continues to rise. In light of this, we develop a compartmental model to assess the impact of the WHO's 90-70-90 strategy, along with adult catch-up vaccination, on the control of HPV-induced cervical cancer in China. We analyze the basic properties of the model and provide proofs of the local and global asymptotic stability of the equilibrium points. Additionally, a sensitivity analysis is performed, and we use the MCMC algorithm to fit the number of new cervical cancer cases and deaths in China from 1990 to 2021. The estimated basic reproduction number before and after the introduction of the HPV vaccine in China is 1.5026 (95% CI: 1.4051-1.6002) and 1.0726 (95% CI: 0.9384-1.2067), respectively. The sensitivity analysis reveals that screening, as a non-pharmaceutical intervention, plays a crucial role in controlling the spread of the disease. We apply the 90-70-90 strategy to predict the future number of new cervical cancer cases and deaths in China. The results indicate that prioritizing the 70-90 target combination is the most cost-effective approach and can achieve the goal of zero new cervical cancer cases by 2061. Finally, an optimal control model is developed to explore the best implementation strategies for HPV vaccination and screening under various plausible scenarios.