Objective Evaluate 1-year outcomes of cervical cancer screening and treatment using primary high-risk human papillomavirus (HPV) testing in women living with human immunodeficiency virus (HIV). Design Prospective cohort study. Setting HIV treatment centre in Botswana. Population Women living with HIV. Methods Participants underwent cervical cancer screening with high-risk HPV testing and triage evaluation at baseline and 1-year follow up. Excisional treatment was offered as indicated. Histopathology was the reference standard. Main outcome measures Persistence, clearance and incidence of high-risk HPV infection; and persistence, progression, regression, cure and incidence of cervical dysplasia. Results Among 300 women screened at baseline, 237 attended follow up (79\%). High-risk HPV positivity significantly decreased from 28\% at baseline to 20\% at 1 year (P = 0.02). High-risk HPV persistence was 46\% and clearance was 54\%; incidence was high at 9\%. Prevalence of cervical intraepithelial neoplasia Grade 2 (CIN2) or higher was most common in participants with incident high-risk HPV (53\%). CIN2 or higher was also common in those with persistent high-risk HPV (32\%) and even in those who cleared high-risk HPV (30\%). Of the high-risk HPV-positive participants at baseline with

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