Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

Background: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in sub-Saharan Africa. Screening for cervical cancer among HIV infected women is crucial as they are more at risk of developing the disease and progressing faster once infected with Human Papilloma Virus (HPV).Methods: We aimed to determine the factors affecting the utilization of cervical cancer screening among HIV infected women above 18 years of age at Kenyatta National Hospital by conducting a cross-sectional mixed quantitative and qualitative methods study. Descriptive and inferential analysis was carried out on quantitative data to determine significant associations with cervical cancer utilization. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising.Results: Three hundred and twenty eight of the total 387 women enrolled reported they had been advised by their health providers to go for screening. However, only 179 (46%) reported cervical cancer screening. Women were more likely to report cervical cancer screening if recommendation by a staff was made (p <0.001), and prior to joining KNH CCC (p <0.001). Qualitatively the main barrier to screening included fear of screening due to concerns about excessive pain or bleeding, lack of proper communication on screening procedures and long waiting timeConclusions: The utilization of cervical cancer screening services was low despite high rates of health care recommendation. The women were more likely to utilize the service if recommendation from the health care worker was made, and if they had ever screened before.

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“…16 That study found previous cervical cancer screening very low at 9.7% but a significant increase to 79.8% after joining the clinic.…”

Section: Discussionmentioning

confidence: 84%

Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study

Njuguna

Ilovi

Muiruri

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…91,102,112,113 Loss to follow-up after initial diagnosis is high, and treatment opportunities are missed. 96,114 Integrating ICC screening and treatment with HIV services could offer improved uptake of screening and treatment outcomes.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

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“…The Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) project, based in Uganda, was developed to examine innovations in cancer prevention for women in LMIC [14–17]. Although other studies in sub-Saharan Africa have examined attitudes of WHIV to cervical cancer screening, none have specifically addressed self-collection of HPV as a screening modality in this population [18]. To further understand the attitudes of WHIV towards self-collected specimens for cervical cancer screening, we surveyed WHIV in Kisenyi, Uganda, to explore their intention to participate in self-collection based cervical cancer screening, and offered women self-collection based testing at the local HIV clinic.…”

Section: Introductionmentioning

confidence: 99%

Self-collection based HPV testing for cervical cancer screening among women living with HIV in Uganda: a descriptive analysis of knowledge, intentions to screen and factors associated with HPV positivity

et al. 2017

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BackgroundWomen living with HIV (WHIV) are disproportionately impacted by cervical dysplasia and cancer. The burden is greatest in low-income countries where limited or no access to screening exists. The goal of this study was to describe knowledge and intentions of WHIV towards HPV self-collection for cervical cancer screening, and to report on factors related to HPV positivity among women who participated in testing.MethodsA validated survey was administered to 87 HIV positive women attending the Kisenyi Health Unit aged 30–69 years old, and data was abstracted from chart review. At a later date, self-collection based HPV testing was offered to all women. Specimens were tested for high risk HPV genotypes, and women were contacted with results and referred for care. Descriptive statistics, Chi Square and Fischer-exact statistical tests were performed.ResultsThe vast majority of WHIV (98.9%) women did not think it necessary to be screened for cervical cancer and the majority of women had never heard of HPV (96.4%). However, almost all WHIV found self-collection for cervical cancer screening to be acceptable. Of the 87 WHIV offered self-collection, 40 women agreed to provide a sample at the HIV clinic. Among women tested, 45% were oncogenic HPV positive, where HPV 16 or 18 positivity was 15% overall.ConclusionsIn this group of WHIV engaged in HIV care, there was a high prevalence of oncogenic HPV, a large proportion of which were HPV genotypes 16 or 18, in addition to low knowledge of HPV and cervical cancer screening. Improved education and cervical cancer screening for WHIV are sorely needed; self-collection based screening has the potential to be integrated with routine HIV care in this setting.

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Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

Cited by 80 publications

References 16 publications

Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study

Factors influencing cervical cancer screening in a Kenyan Health Facility: a mixed qualitative and quantitative study

HIV, Tuberculosis, and Noncommunicable Diseases

Self-collection based HPV testing for cervical cancer screening among women living with HIV in Uganda: a descriptive analysis of knowledge, intentions to screen and factors associated with HPV positivity

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