Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

中文翻译：

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南非艾滋病毒阳性女性宫颈癌发病率的时空建模和绘图：一项全国性研究

全球范围内浸润性宫颈癌 (ICC) 发病率存在差异，尤其是艾滋病毒阳性女性，与艾滋病毒阴性女性相比，她们的风险更高。我们的目的是确定南非艾滋病毒阳性女性中 ICC 的空间、时间和时空发病率以及潜在危险因素。我们纳入了 2004 年至 2014 年南非艾滋病毒癌症匹配研究中诊断出艾滋病毒的女性中的 ICC 病例。我们使用 Thembisa 模型（南非艾滋病毒流行的数学模型）来估计每个城市、年龄组和日历年被诊断出感染艾滋病毒的妇女。我们拟合了贝叶斯分层模型，使用 Besag-York-Mollié 的重新参数化来捕获空间自相关，以估计被诊断为 HIV 的女性中 ICC 发病率的时空分布。我们还研究了贫困、获得医疗服务的机会（使用每个城市的卫生设施数量）和城市化与 ICC 发病率之间的关系。我们修正了我们的估计，以考虑 ICC 案件的确定不足、数据缺失和数据错误。我们纳入了 17,821 例 ICC 病例，结果显示，所有城市和惩教所的 ICC 发病率呈下降趋势，从 2004 年每 10 万人年 306 例下降到 312 例，从 2014 年每 10 万人年 160 例下降到 191 例。在没有任何协变量的模型中，空间相对率 (RR) 的范围为 0.27 至 4.43。在调整协变量的模型中，与最不富裕的城市相比，最富裕的城市的 RR 为 3.18（95% 可信区间 1.82, 5.57），而医疗保健条件较好的城市的 RR 为 1.52（1.03, 2.27）与健康状况较差的城市相比。结果显示，在富裕城市和拥有更多医疗设施的城市，宫颈癌的发病率有所增加。这可能是由于较富裕地区更容易获得医疗保健而推动的。应做出更多努力，确保公平获得卫生服务，包括减少前往卫生中心的交通和加强筛查计划等实体障碍。