Women living with HIV (WLHIV) have a high human papilloma virus (HPV) prevalence, less spontaneous clearance, and more rapid progression to malignancy, with only a small percentage of women with readily visible lesions by visual inspection with acetic acid (VIA)/colposcopy. Furthermore, getting women to participate in screening programmes (health literacy), taking cervical smear samples (health care workers (HCWs), and referring positively tested women to clinics (tracking and conveying results) is problematic in low- and middle-income countries (LMICs) settings due to the high HPV prevalence in WLHIV and other socio-economic reasons. Sending all HPV screen-positive women for further evaluation will overwhelm the already strained VIA/colposcopy services in the country.  VIA and colposcopy methods are also subjective with lower sensitivity and specificity than molecular tests. It is, therefore, necessary to risk-stratify screen-positive women to ensure better management of those at the highest risk for cancer, sparing unnecessary effort and treatment for those with regressing dysplasia (dysplasia with higher regression potential) and thereby rationalize the scarce resources. Additionally, a qualitative study to evaluate feasibility, local adequacy, perception, and acceptability of the proposed cervical cancer programme is needed . This should allow development of a comprehensive, acceptable, locally adequate, and sustainable screening program.