1
|
Olakunde BO, Itanyi IU, Olawepo JO, Liu L, Bembir C, Idemili-Aronu N, Lasebikan NN, Onyeka TC, Dim CC, Chigbu CO, Ezeanolue EE, Aarons GA. Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria. Implement Sci 2024; 19:25. [PMID: 38468266 PMCID: PMC10926605 DOI: 10.1186/s13012-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS gov/ct2/show/study/NCT06128304.
Collapse
Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chinenye Bembir
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology and Anthropology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nwamaka N Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril C Dim
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike O Chigbu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093-0812, USA.
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
| |
Collapse
|
2
|
Tesfaye E, Kumbi B, Mandefro B, Hemba Y, Prajapati KK, Singh SC, Upadhye V, Hajare ST. Prevalence of human papillomavirus infection and associated factors among women attending cervical cancer screening in setting of Addis Ababa, Ethiopia. Sci Rep 2024; 14:4053. [PMID: 38374354 PMCID: PMC10876560 DOI: 10.1038/s41598-024-54754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
Human papillomaviruses (HPVs) are circular, nonenveloped small double-stranded DNA viruses that infect stratified epithelium and can cause a number of life-threatening diseases. HPV is the central risk factor for developing cervical cancer and is estimated that approximately 98% of this disease is associated with oncogenic types of HPV. HPV infection leads to an estimated 266,000 cervical cancer deaths annually. Therefore, the objective of this study was to determine the prevalence of HPV infection and risk factors associated with cervical lesion among women attending the cervical cancer screening clinic at the Ethiopian Family Guidance Association, Addis Ababa. A cross-sectional study was conducted to determine the prevalence of HPV infection. Data were collected using a questionnaire and samples leftover from cervical screening were taken. The leftover swab was air dried and DNA was extracted and amplified by using a PCR. A total of 247 women were included in the study. The prevalence of HPV was 9.72% among the population studied. Of all participants, 27.13% were positive for cervical intraepithelial neoplasia-1 (CIN1). CIN1 positivity was found in half of HPV positive women. Among HPV positive women, half of them had started sexual intercourse at ages 12-17 years and 41.66% were women who gave birth at ages 12-17 years. The high prevalence of HPV and the CIN1 positive group were ages 36-57 and women with multiple sexual partners. The other groups with the highest CIN1 positive were 22.39% grade (9-12) and 20.9% primary (1-8) and uneducated women. Among HPV positive women, 83.33% had an abortion history and 80% miscarried in the first trimester. Among the CIN1 positives, 53.73% had more than two sexual partners. Among HPV positive women, half of them were users of contraception methods. In conclusion, the highest prevalence of HPV is among women who began sexual intercourse earlier and who gave birth at 12-17 years of age, have an abortion history, with MSP and oral contraceptive methods users. In addition to HPV, early pregnancy and sexual intercourse at 12-17 years of age, abortion, MSP, and oral hormonal contraceptives are factors in cervical cancer. Finally, most women do not have enough knowledge and awareness about cervical cancer and the risk factor.
Collapse
Affiliation(s)
- Elsa Tesfaye
- Department of Biology, Faculty of Biomedical Science, College of Natural and Computational Sciences, Dilla University, SNNPR, 419, Dilla, Ethiopia
| | - Birhanu Kumbi
- Department of Biology, Faculty of Biomedical Science, College of Natural and Computational Sciences, Dilla University, SNNPR, 419, Dilla, Ethiopia
| | - Belayihun Mandefro
- Department of Biology, Faculty of Biomedical Science, College of Natural and Computational Sciences, Dilla University, SNNPR, 419, Dilla, Ethiopia
| | - Yadesa Hemba
- Department of Biology, Faculty of Biomedical Science, College of Natural and Computational Sciences, Dilla University, SNNPR, 419, Dilla, Ethiopia
| | | | | | - Vijay Upadhye
- Research & Development cell, Institute of Applied Sciences,Parul University, Vadodara, Gujarat, India
| | - Sunil Tulshiram Hajare
- Department of Biology, Faculty of Biomedical Science, College of Natural and Computational Sciences, Dilla University, SNNPR, 419, Dilla, Ethiopia.
| |
Collapse
|
3
|
Habila MA, Sagay E, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. Utilization of opportunistic cervical cancer screening in Nigeria. Cancer Causes Control 2024; 35:9-20. [PMID: 37530986 DOI: 10.1007/s10552-023-01764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While various interventions have been conducted to decrease cervical cancer's burden in Nigeria, no study has examined the trends in cervical cancer screening uptake over time. The present study sought to fill this gap in knowledge using data collected at Jos University Teaching Hospital (JUTH) in Nigeria. METHODS Data collected continuously between 2006 and 2016 were analyzed to identify trends in screening uptake, changes in risk factors for cervical cancer, and to identify factors for women screened at Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Categorical analyses and logistic regression models were used to describe patient characteristics by year, and to identify factors associated with repeated screening uptake. RESULTS A total of 14,088 women who were screened between 2006 and 2016 were included in the database; 2,800 women had more than one screening visit. Overall, screening uptake differed significantly by year. On average women were first screened at age 38. About 2% of women screened were women living with HIV. Most women (86%) had normal pap smear at first screening, with the greatest decreased risk of abnormalities observed between 2011 and 2014. Odds of a follow-up screening after a normal result decreased significantly between 2008 and 2016 compared to women screened in 2006 and 2007. Finally, women living with HIV had increased odds of follow-up screening after having a normal pap smear. CONCLUSIONS These findings contribute to our understanding of the potential social and health system barriers to cervical cancer control in Nigeria. The findings may assist policy makers to design interventions to increase access and compliance to recommended screening schedules in this vulnerable population.
Collapse
Affiliation(s)
- Magdiel A Habila
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Emmanuel Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
4
|
Factors associated with cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania: A cross-sectional study. Prev Med Rep 2022; 30:101985. [PMID: 36176589 PMCID: PMC9512833 DOI: 10.1016/j.pmedr.2022.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/03/2022] [Accepted: 09/17/2022] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
|
5
|
John-Akinola YO, Ndikom CM, Oluwasanu MM, Adebisi T, Odukoya O. Cervical Cancer and Human Papillomavirus Vaccine Knowledge, Utilisation, Prevention Educational Interventions and Policy Response in Nigeria: A Scoping Review. Cancer Control 2022; 29:10732748221130180. [PMID: 36168955 PMCID: PMC9523857 DOI: 10.1177/10732748221130180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer. METHODS A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. RESULTS Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control. CONCLUSION Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.
Collapse
Affiliation(s)
- Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Chizoma M Ndikom
- Department of Nursing, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Mojisola M Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Temitayo Adebisi
- Department of Radiation Oncology, 107962University College Hospital, Ibadan, Nigeria
| | - Oluwaponmile Odukoya
- Department of Radiation Oncology, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
6
|
Bogale AL, Teklehaymanot T, Haidar Ali J, Kassie GM. Knowledge, attitude and practice of cervical cancer screening among women infected with HIV in Africa: Systematic review and meta-analysis. PLoS One 2021; 16:e0249960. [PMID: 33831128 PMCID: PMC8031808 DOI: 10.1371/journal.pone.0249960] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To establish successful strategies and increasing the utilization of preventive services, there is a need to explore the extent to which the general female population is aware and use the service for cervical cancer-screening among women infected with HIV in Africa. Available evidences in this regard are controversial and non-conclusive on this potential issue and therefore, we estimated the pooled effect of the proportion of knowledge, attitude and practice of HIV infected African women towards cervical cancer screening to generate evidence for improved prevention strategies. METHODS We applied a systematic review and meta-analysis of studies conducted in Africa and reported the proportion of knowledge, attitude and practice towards cervical cancer screening. We searched electronic databases: PubMed/Medline, SCOPUS, ScienceDirect, Web of science, Cumulative Index of Nursing and allied Health Sciences (CINAHL) and Google scholar databases to retrieve papers published in English language till August 2020. We used random-effects model to estimate the pooled effect, and funnel plot to assess publication bias. The registration number of this review study protocol is CRD42020210879. RESULTS In this review, we included eight published papers comprising 2,186 participants. The estimated pooled proportion of knowledge of the participants was 43.0% (95%CI:23.0-64.0) while the pooled estimates of attitudes and practices were 38.0% (95%CI: 1.0-77.0) and 41.0% (95%CI: 4.0-77.0), respectively. The proportion of the outcome variables were extremely heterogeneous across the studies with I2> 98%). CONCLUSION The pooled estimates of knowledge, attitude and practice were lower than other middle income countries calls for further activities to enhance the uptake of the services and establish successful strategies.
Collapse
Affiliation(s)
- Agajie Likie Bogale
- Ethiopian Public Health Institute, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tilahun Teklehaymanot
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Program of Tropical and Infectious Diseases, Addis Ababa, Ethiopia
| | - Jemal Haidar Ali
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
| | | |
Collapse
|
7
|
Kimondo FC, Kajoka HD, Mwantake MR, Amour C, Mboya IB. Knowledge, attitude, and practice of cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania. Cancer Rep (Hoboken) 2021; 4:e1374. [PMID: 33739611 PMCID: PMC8551985 DOI: 10.1002/cnr2.1374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/01/2021] [Accepted: 03/03/2021] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Faustini C Kimondo
- Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Happiness D Kajoka
- Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Meshack R Mwantake
- Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent B Mboya
- Community Health Department, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| |
Collapse
|
8
|
Morhason-Bello IO, Kareem YO, Adewole IF. Modeling for Predictors of Knowledge Score on Etiology and Prevention Strategies for Cervical Cancer Among Women of Reproductive Age in Ibadan. JCO Glob Oncol 2020; 6:892-903. [PMID: 32589467 PMCID: PMC7328104 DOI: 10.1200/go.20.00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Poor knowledge regarding cervical cancer in at-risk populations directly affects health-seeking behavior and is associated with high mortality among women with cervical cancer. This study aims to evaluate the knowledge of women regarding the causes, risk factors, and prevention strategies of cervical cancer. METHODS A multistage cross-sectional study of 1,002 women of reproductive age (18-49 years) in Ibadan was conducted. Knowledge of cervical cancer risk causes and prevention strategies was assessed using 13 and 9 question items, respectively. The knowledge score was graded as 0 (no knowledge), 1-4 (poor knowledge), or ≥ 5 (good knowledge). The proportional or partial proportional odds model was used to fit 3 models using the forward stepwise selection. All analysis was performed using Stata 15.0 (Stata Corp, College Station, TX). RESULTS The median age of participants was 29 years (interquartile range [IQR], 23-35 years). The median knowledge scores of participants on causes and prevention strategies of cervical cancer were 3 (IQR, 0-4) and 3 (IQR, 0-5), respectively. The assessment of knowledge on causes and prevention strategies for cervical cancer revealed that having multiple sexual partners and no previous opportunity for counseling on cervical cancer screening were factors associated with lower odds of knowledge. CONCLUSION The knowledge of women about the risk factors, causes, and prevention strategies of cervical cancer was poor. It is worrisome that poor knowledge was common among women with potential demographic risk factors for cervical cancer. We recommend innovative community mobilization to improve women’s knowledge of the risk factors associated with cervical cancer and prevention strategies.
Collapse
Affiliation(s)
- Imran O Morhason-Bello
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Yusuf Olushola Kareem
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Isaac F Adewole
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
9
|
Kasraeian M, Hessami K, Vafaei H, Asadi N, Foroughinia L, Roozmeh S, Bazrfashan K. Patients' self-reported factors influencing cervical cancer screening uptake among HIV-positive women in low- and middle-income countries: An integrative review. Gynecol Oncol Rep 2020; 33:100596. [PMID: 32551354 PMCID: PMC7292910 DOI: 10.1016/j.gore.2020.100596] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 01/10/2023] Open
Abstract
This review reveals barriers of cervical cancer screening among HIV-positive women. The uptake of cervical cancer screening among HIV-positive women is very low. We reported personal, social and structural barriers of cervical cancer screening.
Cervical cancer is among the most common causes of cancer-related deaths in low- and middle-income countries (LMICs). Despite the strong evidence regarding cervical cancer screening cost-effectiveness, its utilization remains low especially in high risk populations such as HIV-positive women. The aim of this review was to provide an overview on the patient-reported factors influencing cervical cancer screening uptake among HIV-positive women living in LMICs. We systematically searched EMBASE, PUBMED/MEDLINE and Web of Science databases to identify all quantitative and qualitative studies investigating the patient-reported barriers or facilitators to cervical cancer screening uptake among HIV-positive population from LMICs. A total of 32 studies met the inclusion criteria. A large number of barriers/facilitators were identified and then grouped into three categories of personal, social and structural variables. However, the most common influential factors include knowledge and attitude toward cervical cancer or its screening, embarrassment, fear of cervical cancer screening and test results, patient-healthcare provider relationship, social support, screening costs and time constraints. This review’s findings highlighted the need for multi-level participation of policy makers, health professionals, patients and their families in order to overcome the barriers to uptake of cervical cancer screening among HIV-positive women, who are of special concern in LMICs.
Collapse
Affiliation(s)
- Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrfashan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Belglaiaa E, Souho T, Badaoui L, Segondy M, Prétet JL, Guenat D, Mougin C. Awareness of cervical cancer among women attending an HIV treatment centre: a cross-sectional study from Morocco. BMJ Open 2018; 8:e020343. [PMID: 30139893 PMCID: PMC6112383 DOI: 10.1136/bmjopen-2017-020343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To explore awareness about cervical cancer among Moroccan women attending an HIV treatment centre in Laâyoune city, Morocco. DESIGN A cross-sectional study was conducted from April to June 2017 using a knowledge test regarding cervical cancer, its risk factors and its prevention. SETTING HIV treatment centre at the Hospital of Moulay Hassan Ben Elmehdi in Laâyoune city, Morocco. PARTICIPANTS One hundred and twenty-three HIV-positive women aged 19 years and older were recruited to this study. RESULTS A total of 115 women were eligible to participate in the study. The average age was 34.9±10.2 years. Few women (20%) had heard about cervical cancer and its screening, the majority (17.4%) having received information from mass media. The vast majority (79.1%) of respondents had no knowledge of cervical cancer risk factors, and 80.8% did not know any symptoms of cervical cancer. Only 13% had undergone a Pap smear test. The main reason for not seeking Pap smear was the absence of symptoms (47%). CONCLUSION Our study documents poor awareness of cervical cancer. Given that the HIV-positive population is at increased risk of cervical cancer, health education programmes should be promoted to increase awareness of cervical cancer as well as access and participation in cervical cancer screening.
Collapse
Affiliation(s)
- Essaada Belglaiaa
- Service des soins infirmiers, Institut Supérieur des Professions Infirmières et Techniques de Santé, Laâyoune, Morocco
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
| | - Tiatou Souho
- Faculté des Sciences et Techniques, Université de Kara, Kara, Togo
| | - Latifa Badaoui
- Service de Médecine, Hôpital Moulay Hassan ibn Mehdi, Laâyoune, Morocco
| | - Michel Segondy
- INSERM UMR1058 Pathogenèse et contrôle des infections chroniques, Université de Montpellier, Montpellier, France
| | - Jean-Luc Prétet
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - David Guenat
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - Christiane Mougin
- EA 3181, LabEx LipSTIC ANR-11-LABX-0021, Université Bourgogne Franche-Comté, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| |
Collapse
|