The proposal's overall aim is to improve cervical cancer prevention programs for HIV_x0013_infected women in Africa, by evaluating the effectiveness and cost-effectiveness of alternative screening strategies, and by developing algorithms leading to earlier detection and management of cervical cancer in these high-risk populations. The proposal's hypotheses are that: i) the use of simplified point of care diagnostic tests to detect high-risk (HR) HPV DNA , never before evaluated in Africa, alone or combination with other tests in various triage strategies has the potential to improve the coverage of cervical cancer screening in high-risk populations, and that it will prove a cost-effective cervical cancer prevention intervention in the long term; and ii) immune restoration and control of HIV replication through highly active antiretroviral therapy (HAART) or HAART initiation improves clearance of HPV infection among high-risk (HR)-HPV infected women, therefore slowing the development or progression of cervical precursor lesions. These findings may suggest that varying strategies or frequencies of screening may be required for women on HAART or not. The study will enroll 1200 HIV positive women (half on HAART or about to start HAART; and half with high CD4 count>350) in Burkina Faso and South Africa in a cross-sectional evaluation of cervical cancer screening strategies, from which about 1100 HIV-infected women without CIN2+ will be followed at one year to detect incident CIN2+ and persistence, incidence and clearance of HR HPV. A costing and modelling studies will determine the cost-effectiveness of triage strategies targeting HIV+ women.