Investigators pooled data from 44 primary studies encompassing 47,009 women living with HIV. The meta-analysis produced a pooled prevalence of precancerous cervical lesions (PCCL) of 22.25% (95% CI: 19.57–24.93). The figure is not uniform across sites. Reported point estimates in the source ranged from 1.87% in one country to 76.00% in another, indicating extreme variability within the region. That spread suggests local program performance, screening modalities, or population differences likely influence measured burden.
The review team used standard methods to quantify pooled prevalence and to explore heterogeneity. The source reported subgroup and sensitivity analyses as part of the statistical approach; publication-bias assessment was also undertaken, according to the authors. Specific numerical outputs for subgroup comparisons and heterogeneity statistics were presented in the original article; the source should be consulted for the detailed forest plots and I2 values.
The study team summarized associations between clinical, behavioral, and reproductive factors and PCCL among WLHIV. Investigators reported the following factors with statistically significant elevated odds (source-provided odds ratios): age at first sexual intercourse less than 18 years (OR = 2.99), multiparity (OR = 4.97), having multiple sexual partners (OR = 3.06), a history of sexually transmitted infections (OR = 3.93), smoking (OR = 7.01), ever using oral contraceptive pills (OR = 2.69), low CD4 count (OR = 1.79), and not initiating ART (OR = 2.02).
Some associations were large in magnitude—smoking and multiparity among them—while others were more modest, such as low CD4 count. The source expressed associations as odds ratios and used a p-value threshold of <0.05 to denote statistical significance. The authors noted that behavioral and clinical exposures, together, appear to contribute to elevated PCCL risk in WLHIV in the included Southern and Eastern African studies.
The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251123583). Investigators included original primary studies from Southern and Eastern Africa published through August 15, 2025. Both published and unpublished studies were eligible. The authors applied the Newcastle–Ottawa Scale to assess methodological quality of included studies. Data extraction was performed using Microsoft Excel and pooled analyses were executed in STATA 17. The source indicates that subgroup, sensitivity, and publication-bias analyses were performed; exact thresholds and the full search strategy are provided in the original paper and its supplementary files.
The source excluded studies that did not report the outcomes of interest, reviews, case reports, letters, protocols, studies without full texts, and articles failing quality-assessment standards. These screening rules were described in the methods section of the article.
Authors recommended targeted interventions addressing the factors associated with PCCL. They urged stakeholders to implement measures that could reduce future PCCL incidence among WLHIV. Specific programmatic areas highlighted by the analysis include earlier and sustained ART initiation and strengthened sexual-health services that prevent and manage sexually transmitted infections. Reproductive-health counseling around parity and contraceptive use was reported as relevant in the context of observed associations. Tobacco-use interventions also emerged as a potential preventive target, given the strong association between smoking and PCCL reported in the pooled analysis.
The report reiterated established prevention strategies: vaccination against human papillomavirus (HPV) and screening using appropriate tests (HPV DNA testing, visual inspection methods, or cytology) followed by timely treatment in a screen-and-treat model, consistent with World Health Organization guidance. The source did not provide new clinical trial data on interventions; rather, it synthesized observational associations to inform program priorities.
The included studies produced widely divergent prevalence estimates, from under 2% to three-quarters of sampled women in different reports. That heterogeneity points to persistent knowledge gaps. Investigators performed subgroup and sensitivity analyses to explore variability; full stratified results and heterogeneity statistics are available in the article’s figures and supplementary tables.
The SRMA consolidated consistent associations across many studies, yet it also reflected the uneven quality and context-specific differences of primary research across Southern and Eastern Africa. The wide range of reported prevalence, together with differing study designs and screening methods, remains an unresolved issue that the authors document. Targeted research that harmonizes screening definitions and evaluates how program-level factors (screening access, test type, and linkage to treatment) influence measured PCCL prevalence would address these gaps. The article ends by asking stakeholders to prioritize interventions addressing the identified risk factors and by documenting the substantial between-country variability that requires more standardized, context-sensitive data collection.