Potential Impact of Catch‐Up HPV Vaccination on HPV Prevalence and Cervical Cancer Incidence Among Women Living With HIV in South Africa: Results From Two Mathematical Models

ABSTRACT Introduction Women living with HIV (WLHIV) face an increased risk of cervical cancer (CC). With inequitable human papillomavirus (HPV) vaccine access globally and a programmatic focus on girls‐only school‐based delivery, many WLHIV in high HIV prevalence countries remain vulnerable to HPV and CC. We assessed the incremental impact of adding catch‐up vaccination for WLHIV in South Africa. Methods We used two independently developed HPV/CC and HIV transmission models to predict the incremental impact of catch‐up HPV vaccination for WLHIV compared to routine‐only vaccination of girls aged 9−14 (90% cohort coverage) from 2020 onwards using a nonavalent vaccine (lifelong 100% protection). We assessed catch‐up scenarios vaccinating WLHIV aged 15−24 or ≥15 (attaining 90% cohort coverage), maintaining baseline CC screening. We report the predicted median annual prevalence of vaccine‐type high‐risk HPV (VT HR‐HPV), CC incidence and cumulative fraction of CC cases averted compared to routine‐only vaccination among WLHIV overall (age‐standardized) and by age. Results With routine‐only vaccination, overall coverage among all WLHIV remained substantially (>50%) lower than in all women for 35−40 years, with gaps persisting even after 80 years. Adding catch‐up vaccination for WLHIV aged 15−24 increased coverage and benefits mainly among young WLHIV, with the largest annual reductions (relative to routine‐only vaccination) in VT HR‐HPV prevalence and CC incidence for WLHIV