Qualitative Study of the Role of Pap Screening on HPV Transmission Dynamics

ALI JAVAME, ABBA B. GUMEL

Abstract


A new deterministic model is designed and used to assess the population-level impact of Pap cytology screening on the transmission dynamics of human papillomavirus (HPV), and associated dysplasia, in a community. In the absence of Pap screening, the disease-free equilibrium (DFE) of the resulting model is shown to be globally-asymptotically stable whenever the associated reproduction number (R0 ) is less than unity. Furthermore, the model has a unique endemic equilibrium, which is locally- and globally- asymptotically stable for special cases. The disease-free equilibrium of the Pap screening model is also shown to be globally-asymptotically stable when its reproduction number (R0s ) is less than unity. The effect of uncertainties in the estimates of the parameter values used in the numerica simulations of the Pap screening model is accounted for via uncertainty and sensitivity analysis. Numerical simulations of the Pap screening model show that HPV transmission models that do not incorporate disease transmission by individuals in the pre-cancerous stages may under-estimate the burden of HPV (and associated dysplasia) in the community. Although Pap screening significantly reduces the incidence of cervical cancer (for instance, detecting 50% of sexually-active females with cervical intraepithelial neoplasia resulted in 95% reduction of cervical cancer cases over 10 years), its singular use is insufficient to lead to the effective control of the spread of HPV in the community.


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