Knowledge, attitude, and practice of cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania

Awareness, attendance, and attitudes toward cervical cancer screening among HIV-positive Chinese women in Yunnan province: a cross-sectional study

BACKGROUND

Cervical cancer is a major health threat in the female population. Human immunodeficiency virus (HIV)-positive women encounter a higher risk of cervical cancer. It is significant to promote cervical cancer screening attendance among HIV-positive women. Little is known about the awareness, attendance, and attitudes toward cervical cancer screening, as well as the associated factors, among Chinese HIV-positive women.

METHODS

A cross-sectional study was conducted among 411 HIV-positive women attending a large ART clinic in Yunnan, an HIV-endemic province in China. Participants were recruited using the convenient sampling method from January 2019 to August 2020. An interviewer-administered semi-structured questionnaire was utilized to collect information on socio-demographic and behavioral characteristics, clinical characteristics related to HIV infection, awareness, attendance, and attitudes toward cervical cancer screening. Binary logistic regression analyses were used to determine factors associated with awareness, attendance, and attitude toward cervical cancer screening.

RESULTS

Some 69.8% (287) of the participants were aware of cervical cancer screening, but only 27.7% (114) had attended screening within 3 years. After receiving a brief health education, 72.3% (297) of the participants exhibited a positive attitude toward cervical cancer screening. Participants with a higher education background and longer duration of antiretroviral therapy were more likely to be aware of cervical cancer screening and have up-to-date screening. The up-to-date screening attendance was also influenced by age, smoking status, and health insurance. Single participants were less likely to show a positive attitude toward cervical cancer screening compared married or cohabiting counterparts. The main facilitators to attending cervical cancer screening were health promotion activity and well-organized programs, while the main barriers were high costs of the service and inadequate awareness.

CONCLUSIONS

Although most HIV-positive women attending a large ART clinic in Yunnan were aware of cervical cancer screening, the up-to-date attendance was low. It is crucial to conduct health education and promotion through efficient channels to improve awareness and attendance. The discrepancy between awareness and attendance also emphasized the importance of adopting appropriate screening strategies and powerful health policies that can foster the attendance of cervical cancer screening among HIV-positive women. Efforts should be devoted to constructing a comprehensive healthcare system with high accessibility in China for cervical cancer prevention and management for HIV-positive women.

Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study

BACKGROUND

Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death.

OBJECTIVE

We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda.

METHODS

In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis.

RESULTS

The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake.

CONCLUSION

Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.

The Role of Health Information Sources on Cervical Cancer Literacy, Knowledge, Attitudes and Screening Practices in Sub-Saharan African Women: A Systematic Review

Cervical cancer is the leading cause of cancer deaths among Sub-Saharan African women. This systematic review aimed to identify information sources and their relation to cervical cancer knowledge, literacy, screening, and attitudes. Peer-reviewed literature was searched on 2 March 2022, and updated on 24 January 2023, in four databases-CINAHL Plus, Embase, PubMed, and Web of Science. Eligible studies included those that were empirical, published after 2002, included rural women, and reported on information sources and preferences. The quality of the selected articles was assessed using the Mixed Methods Appraisal Tool. Data extraction was conducted on an Excel spreadsheet, and a narrative synthesis was used to summarize findings from 33 studies. Healthcare workers were the most cited information sources, followed by mass media, social networks, print media, churches, community leaders, the Internet, and teachers. Community leaders were preferred, while healthcare workers were the most credible sources among rural women. There was generally low cervical cancer knowledge, literacy, and screening uptake, yet high prevalence of negative attitudes toward cervical cancer and its screening; these outcomes were worse in rural areas. A content analysis revealed a positive association of health information sources with cervical cancer literacy, knowledge, screening, and positive screening attitudes. Disparities in cervical cancer prevention exist between rural and urban Sub-Saharan African women.

Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey

BACKGROUND

The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania.

METHODS

We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30-49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18.

RESULTS

Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4-2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1-1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7].

CONCLUSION

The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities.

HIV status and knowledge of cervical cancer among women in Ghana

BACKGROUND

Cervical cancer remains a disease of significant concern to women's health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH).

METHODS

This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis.

RESULTS

The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education.

CONCLUSIONS

To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

Awareness, Knowledge and Attitude Regarding Cervical Cancer among Women Living with HIV in the Souss-Massa Region, Southern Morocco: A Cross-Sectional Study

BACKGROUND

Human immunodeficiency virus- positive women have an increased risk of precancerous lesions and invasive cervical cancer. This study aims to identify the level of awareness/knowledge and attitudes toward cervical cancer among women living with Human immunodeficiency virus in the region of Souss-Massa in southern Morocco.  Methods: This is a multicenter cross-sectional study conducted in the Souss-Massa region (southern Morocco) among women attending Human immunodeficiency virus treatment and care centers between March 2022 and September 2022. A questionnaire was used for data collection. The Chi-square test and logistic regression were deployed to identify factors associated with cervical cancer awareness among the target population.

RESULTS

A total of 494 respondents to the questionnaire, 440 (89.1%) are aware of cervical cancer. Nevertheless, 405 (82.0%) and 369 (74.7%) were unaware of cervical cancer risk factors and symptoms, respectively. Only 125 (25.3%) knew the exact frequency of cervical cancer screening among Human immunodeficiency virus positive women, whereas 221 (44.7%) had ever been tested for cervical cancer. Factors associated with women's awareness of cervical cancer are as follows:  level of education (adjusted Odds Ratio = 3.78 with 95% CI, 1.23-11.65), time since diagnosis of Human immunodeficiency virus (adjusted Odds Ratio = 4.31 with 95% CI, 1.12- 16.52), knowledge of women with cervical cancer (adjusted Odds Ratio = 6.30 with 95% CI, 1.87-21.18) and heard the pap- smear/visual inspection with acetic acid (adjusted Odds Ratio = 4.92 with 95% CI, 2.35-10.33).

CONCLUSION

The general knowledge of seropositive women regarding cervical cancer remains very low, which justifies the integration of cervical cancer prevention services with Human immunodeficiency virus care, and pinpoints the crucial role of patient education.

Cervical cancer in Northern Tanzania-What do women living with HIV know

Background

Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania.

Methods

This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) at KCMC. A pre-tested questionnaire was used to collect quantitative data. Both descriptive and regression methods were used to determine CC knowledge, awareness, and beliefs as well as factors associated with knowledge of CC among WLHIV using SPSS version 23.

Results

Participants' mean age was 46 ± 10.4 years. Although just half (54.7%) of WLHIV had insufficient knowledge of CC, the majority of the participants (83.5%) were able to recognize at least three risk factors, but with limited understanding of symptoms and prevention. The majority held positive beliefs on CC and screening practices. Factors associated with good knowledge of CC included being married (AOR: 3.66, 95% CI: 1.84-7.28), having used ART for at least 2 years (AOR: 4.08, 95% CI: 1.36-12.21), and having previously screened for CC (AOR: 1.62, 95% CI: 1.01-2.59).

Conclusion

WLHIV attending care and treatment center had insufficient knowledge about CC screening. To further improve screening and treatment for CC, at both facility and community levels, targeted awareness and education campaigns are warranted.

Factors associated with cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania: A cross-sectional study

Despite cervical cancer being a highly preventable disease, it is the fourth most common cancer among women in both incidence and mortality. Cervical cancer screening is crucial in preventing the disease. Women living with HIV (WLHIV) are at higher risk of cervical cancer because of their immune-compromised state. We aimed to determine factors associated with cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania. A cross-sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in northern Tanzania between August 21 and September 3, 2020; and interviewed using a questionnaire. Logistic regression model determined factors associated with cervical cancer screening at 5% significance level. Half (50.2 %) of the 297 WLHIV had ever screened for cervical cancer. WLHIV with positive attitudes towards cervical cancer screening (AOR = 3.48, 95 % CI 1.86, 6.51) and those who received information on cervical cancer from Health Care Providers (HCP) (AOR = 17.31, 95 % CI 6.00, 50.22) had higher odds of ever being screened for cervical cancer. Lower odds of screening (AOR = 0.50, 95 % CI 0.27, 0.96) were among women diagnosed with HIV within the past three years. WLHIV having a positive attitude towards screening and received cervical cancer screening information from HCP, were likely to have ever screened. Women newly diagnosed with HIV are less likely to have ever screened. HCPs at CTC are an important source of information about screening and for promoting cervical cancer screening among WLHIV. Special attention should be given to women newly diagnosed with HIV.

Knowledge, attitude, and practice of cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania

Background

Cervical cancer is the fourth most common cancer globally among women in incidence and mortality. Women living with HIV (WLHIV) are disproportionately at a higher risk of developing the disease.

Aim

To determine the knowledge, attitude, and practice of cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania, following the integration of these services in routine HIV care in the country.

Methods and results

A cross‐sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in Hai district and Mawenzi regional hospitals in northern Tanzania between 21 August and 3 September 2020. A questionnaire was used for data collection using face‐to‐face interviews. Data were analyzed using SPSS version 20.0. Frequencies and percentages summarized categorical variables and numerical variables summarized using median and interquartile range (IQR). About half (50.2%) of 297 WLHIV in this study had ever screened for cervical cancer, and 64% screened within the past 12 months preceding the survey. Although 90% ever heard of cervical cancer screening, only 20.5% knew when WLHIV should start screening. Over half (52.5%) had adequate knowledge of prevention, 38.4% on risk factors, and 27.9% of cervical cancer signs and symptoms. Two‐thirds (66.7%) had positive attitudes toward cervical cancer screening. A major source of cervical cancer screening information was the health care providers (80.1%) and the mass media (66%), particularly radio.

Conclusions

The WLHIV in this study had inadequate knowledge but favorable attitudes toward cervical cancer screening, while half had screened for cervical cancer. Efforts should be directed to capacity building of health care providers at CTC and scaling up the mass media campaigns as relevant interventions to promote the uptake of cervical cancer screening programs among WLHIV in Tanzania.