Knowledge and use of papanicolaou test among HIV-positive women

Knowledge and Practice of Women With HIV on Cervical Cancer Prevention and Control and their Attributes to Utilize the Screening Services in Ethiopia: A Cross Sectional Study

BACKGROUND

Previous studies underscore the crucial link between awareness and timely cervical cancer screening and treatment, particularly among women of reproductive age. Yet, insights remain limited when it comes to women living with HIV in Addis Ababa. This study examined the knowledge and practices of these women regarding cervical cancer screening and treatment, illuminating the factors that both enable and hinder their uptake.

METHODS

This cross-sectional study took place in six public hospitals in Addis Ababa, Ethiopia, involving 578 women with HIV. The recruitment spanned 10 months, from January 1st to October 31st, 2021. Trained clinicians utilized the Open Data Kit for data collection, ensuring real-time submission to the server. Statistical analysis was performed using SPSS version 25, employing descriptive and inferential statistics. The logistic regression model identified predictors of outcome variables, and open-ended questions were thematically narrated for qualitative insights.

RESULTS

A notable 51.2% of women with HIV exhibited inadequate knowledge regarding cervical cancer prevention and control programs. Furthermore, a substantial 68.5% had never undergone cervical examination, citing reasons such as considering themselves healthy (49.6%), perceiving the examination as painful (28.4%), and feeling shy to undergo screening (23.3%). Notably, participants with non-formal education were 70% less likely to possess knowledge about cervical cancer prevention and control (AOR = 0.30; 95% CI = 0.13-0.71). Income emerged as an independent predictor for both knowledge and practice in women's approach to cervical cancer prevention and control (P < 0.05). Additionally, occupation and duration of HIV diagnosis independently predicted practice, even after adjusting for confounding factors.

CONCLUSION

Half of the participating HIV-positive women lacked adequate awareness about cervical cancer prevention and control, underscoring the urgent need for comprehensive awareness initiatives tailored to this population. Relevant ministries, health care providers, and advocacy groups must collaborate to implement targeted education programs, utilizing diverse channels like community outreach, health care settings, and media campaigns.

Low uptake of cervical cancer screening among HIV positive women in Gondar University referral hospital, Northwest Ethiopia: cross-sectional study design

BACKGROUND

Cervical cancer is one of the leading causes of death in women worldwide. Majority of the cases are found in developing countries. The increasing risk of cervical cancer death and the high prevalence of human papilloma virus (HPV) infection in Human immuno-deficiency virus(HIV) positive women calls for determining the level of premalignant cervical cancer (Ca) screening uptake. So, this study aimed to assess the uptake of cervical cancer screening and its associated factors.

METHODS

An institution based cross sectional study was conducted from April to May, 2016, among adult HIV positive women attending care and treatment at Gondar University Referral Hospital. The data were collected using an interviewer administered questionnaire. Bivariate and multivariable logistic regression analyses were used to determine the presence and the degree of association between dependent and independent variables. In the multivariable logistic analysis, a P-value of < 0.05 and odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer(Ca) screening.

RESULTS

The life-time uptake of cervical cancer screening among HIV positive women was 10% (95% Confidence Interval(CI): 7.3-12.8). In multivariable the analysis, women with primary education (Adjusted Odds Ratio(AOR) = 3.92, 95%CI:1.70-8.99), secondary education (AOR = 3.84, 95%CI: 1.50-9.83), and tertiary level education (AOR = 4.16, 95%CI: 1.24-13.98), having a child (AOR = 3.02, 95%CI: 1.23-7.46), diagnosed as HIV positive ten years back or more (AOR = 2.71, 95% CI: 1.06-6.97), and Cell Differentiation 4(CD4) count of less than or equal to 200cell/mm3 (AOR = 5.29, 95% CI: 2.58-10.83) were significantly associated with the uptake of cervical cancer screening.

CONCLUSION

In this study, the uptake of cervical cancer screening was very low. Educational status, parity, length of time after diagnosis as HIV positive, and CD4 count are important predictors of cervical cancer screening. Health care workers and cervical cancer prevention and control program coordinators and implementers need to provide counseling services for all Anti-retroviral Therapy(ART) care attendants. So as to explore the root causes for the low utilization of precancerous stage of cervical Ca screening service, conducting a study on the supply side with a qualitative component is mandatory.

Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

Background

The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.

Methods

A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.

Results

A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age ≥45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/μl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.

Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.

Conclusions

In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.

Frequency of Gynecologic Follow-Up and Cervical Cancer Screening in the Swiss HIV Cohort Study

BACKGROUND

According to current recommendations, HIV-infected women should have at least 1 gynecologic examination per year.

OBJECTIVES

To analyze factors associated with frequency of gynecologic follow-up and cervical cancer screening among HIV-infected women followed in the Swiss HIV Cohort Study (SHCS).

METHODS

Half-yearly questionnaires between April 2001 and December 2004. At every follow-up visit, the women were asked if they had had a gynecologic examination and a cervical smear since their last visit. Longitudinal models were fitted with these variables as outcomes.

RESULTS

A total of 2186 women were included in the analysis. Of the 1146 women with complete follow-up in the SHCS, 35.3% had a gynecologic examination in each time period, whereas 7.4% had never gone to a gynecologist. Factors associated with a poor gynecologic follow-up were older age, nonwhite ethnicity, less education, underweight, obesity, being sexually inactive, intravenous drug use, smoking, having a private infectious disease specialist as a care provider, HIV viral load <400 copies/mL, and no previous cervical dysplasia. No association was seen for living alone, CD4 cell count, and positive serology for syphilis.

CONCLUSIONS

Gynecologic care among well-followed HIV-positive women is poor and needs to be improved.