Precancerous Cervix in Human Immunodeficiency Virus Infected Women Thirty Years Old and above in Northern Uganda

Prevalence and risk factors associated with precancerous and cancerous cervical lesions among HIV-infected women in University of Gondar specialized comprehensive referral hospital, Northwest Ethiopia: cross-sectional study design

BACKGROUND

Cervical cancer is one of the leading causes of death in women worldwide. The majority of the cases are found in developing countries. The increasing risk of cervical cancer prevalence and growing danger of death from cervical cancer and the high occurrence of human papillomavirus (HPV) infection in women who are HIV positive give us the ground to study the prevalence and associated risk factors.

OBJECTIVE

The study aims to assess the prevalence of cervical cancer screening and associated risk factors among HIV-positive women attending the Adult ART clinic at the University of Gondar Hospital.

METHODS

An institution-based cross-sectional study was conducted from March to August 2021, on adult HIV-positive women attending the Adult ART clinic at Gondar University Referral Hospital by phone calling patients per week for six months to complete a total of 2744 HIV-positive patients who were not screened for cervical cancer before. 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 prevalence of premalignant or malignant cervical lesions among HIV-positive patients.

RESULT

This study assessed 915 HIV Positive women who were screened for cervical cancer via visual inspection with acetic acid (VIA) as the primary screening tool and found that 24.48% had positive VIA results. Those with VIA-positive cases pathology examination showed 72.4% had abnormal pathology reports (CIN 1/2/3-51.25%, 17.23% cancer & 3.9% CIS), strengthening the finding in many studies that suggest HIV-positive women have a high rate of premalignant lesions.

Precancerous cervical lesion and associated factors among HIV-infected women in Ethiopia: systematic review and meta- analysis

BACKGROUND

Despite several preventative and control measures Ethiopia continues to see an increase in cervical cancer. Comprehensive evidence is very important to suggest ministry of health. Therefore, the aim of this study is to estimate the pooled violence of Precancerous Cervical Lesion and to identify associated factors among women living with HIV AIDS in Ethiopia.

METHODS

From February 15, 2024 to March 17, 2024, systematic and methodical search of the literature was conducted using electronic databases such as PubMed, HINARI, Global Health, Scopus, EMBASE, Web of Science, African Journal online (AJOL), and Google Scholar. Quality appraisal was assessed based on Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional study using 9 criteria. The Cochrane Q and I2 test statistics were used to verify the heterogeneity of the studies. Using a fixed effect model, the pooled estimate prevalence of precancerous cervical lesion among women living with HIV was calculated.

RESULTS

After reviewing 9,470 studies, 9 studies involving 2,910 women with HIV were included. The pooled estimate of precancerous cervical cancer among women living with HIV in Ethiopia was 15.34% (95% CI: 8.97, 21.72). Having history of sexual infection (POR = 3.12; 95% CI: 1.38, 7.05), having multiple sexual partner (POR = 3.14; 95% CI: 2.29, 4.30), and parity greater than two (POR = 4.97; 95% CI: 3.17, 7.78) were identified factors associated with precancerous cervical lesion.

CONCLUSION

This study found that about one-six of HIV-positive women developed precancerous cervical lesion. According to this study, there was a substantial correlation between precancerous cervical lesion among HIV-positive women and having history of sexually transmitted infection, having multiple sexual partners, and being multipara. In order to reduce precancerous cervical lesion, FMOH, policy makers, and interested parties should pay particular attention to this issue.

Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross-sectional study

Background and Aims

Cervical cancer is a global public health problem and the second most common cancer which leads to morbidity and mortality among women in developing countries like Ethiopia. In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018 alone. This study aimed to assess the prevalence and associated factors of precancerous cervical lesions among women on antiretroviral therapy (ART) at Dukem Health Center, Central Ethiopia.

Methods

An institution-based cross-sectional study was carried out among randomly selected 257 women receiving ART at Dukem Health Center. Data were collected using a pretested structured questionnaire, medical record review, and visual inspection with acetic acid. Collected data were entered into Epi-info 7.4 and exported to SPSS version 26 for analysis. The prevalence of precancerous cervical lesions and the characteristics of study participants were identified. Utilizing both binary and multivariable logistic regression models, the existence and degree of association with precancerous cervical lesions were determined with a p value < 0.05 and a 95% confidence interval.

Results

The prevalence of precancerous cervical lesions was 16% (95% CI: 11.7-20.6). Significant association was found between precancerous cervical lesions and a history of STIs (AOR = 4.30, 95% CI: 1.48-12.49), oral contraceptive use (AOR = 6.56, 95% CI: 2.10-20.50), having multiple lifetime sexual partners (AOR = 2.53: 95% CI: 1.05-6.10), and a recent CD4 count of less than 200 cells/mm3 (AOR: 11.33, 95% CI: 2.88-24.58).

Conclusion

In the study area, the prevalence of precancerous cervical lesions was relatively high. Therefore, concerned bodies are recommended to increase awareness of the prevention of sexually transmitted diseases and limit sexual partners.

Cervical Cancer Screening Practice Among Women: A Community Based Cross-Sectional Study Design

Early detection of cervical cancer through screening practice in developing countries is still low. The study is aimed to determine cervical cancer screening practice and associated factors among women of age 25 to 59 years old. Community-based study design was employed and systematic sampling was used to get 458 samples. The data were entered into Epi info version 7.2.1.0 and exported to SPSS version 20 for cleaning and analysis. Binary and Multivariable Logistic regression was used and adjusted odds ratio with 95% CI at P-value <.05 was reported as significant value. Cervical screening practice among the study participants was 15.5%. Women's age 40 to 49 (AOR = 2.95, 95% CI = 0.94, 9.28), educational status (AOR = 4.19, 95% CI = 1.31, 13.37), employed women (AOR = 2.59, 95% CI = 1.01, 6.68), parity above 4 (AOR = 3.09, CI = 1.03, 9.31), sexual partners 2 to 3 (AOR = 5.32, CI = 2.33, 12.14), good knowledge about cervical cancer (AOR = 3.88; 95% CI = 1.83, 8.23) and positive attitude toward cervical cancer (AOR = 5.92, CI = 2.53, 13.87) were independently associated with cervical cancer screening practices. The study revealed that the utilization of cervical cancer screening was very low. Educational status, Women's age, number of sexual partners, knowledge, and attitude were significantly associated with cervical cancer screening practice. Therefore, intervention programs intended at improving cervical cancer screening practice among women should focus on the significant factors.

Precancerous Cervical Lesion Among Adult Women With Human Immune Deficiency Virus on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia: A Hospital-Based Cross-Sectional Study

Background

Cervical cancer is the fourth most frequent cancer in women representing 6.6% of all female cancers occurring in low and middle-income countries, where resources for cancer prevention programs are often scarce. So this study aimed to assess the prevalence of precancerous cervical lesion and associated factors among adult women with human immune deficiency virus (HIV) on Anti Retroviral Therapy (ART) at Saint Peter Specialized Hospital, Addis Ababa, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from November 06 to July 20, 2020 among 267 adult women with HIV on Anti Retroviral Therapy At Saint Peter Specialized Hospital, Ethiopia. Data were collected using face-to-face interview, patient chart review, and the examination of the squamo-columnar junction by the visual inspection with the acetic acid method. The collected data were entered into Epi-data version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 24.0 for analysis. Bivariate and multivariable binary logistic regression analysis were used to identify factors associated with the precancerous cervical lesion. Statistical significance was considered at a P-valve less than 0.05.

Result

A total of 267 women who were on ART were included in the study and the prevalence of precancerous cervical lesion was 7.5% with 95% CI =4.10%-10.50%. Modern family planning (AOR = 4.14, 95% CI = 1.23-13.87), history of sexual transmission infection (STI) (AOR=5.39, 95% CI= 1.56-18.70) and viral load (AOR=20.85, 95% CI = 6.19-70.25) had significant association with precancerous cervical lesion

Conclusion

In this study, the prevalence of precancerous cervical lesion is relatively low compared to studies in low and middle-income countries. Modern family planning, history of sexual transmitted infection, and viral load had a significant association with a precancerous cervical lesion. Hence, encouraging modern family planning, and routine screening of women for pre-cancerous cervical lesions for those with high viral load have enormous contributions to decreasing cervical cancer disease among Women with Human Immune Deficiency Virus through Anti Retroviral Therapy.

Precancerous Lesions of the Cervix and Associated Factors among Women of East Gojjam, Northwest Ethiopia, 2020

BACKGROUND

Cervical cancer is the commonest cancer of women's reproductive system, and is caused by a progression of precancerous lesions of the cervix. Studies on the prevalence and associated factors of precancerous lesions of the cervix are very limited in Ethiopia, particularly in the study area.

OBJECTIVE

This study aimed to assess precancerous lesions of the cervix and associated factors among women of East Gojjam, northwest Ethiopia in 2020.

METHODS

A facility-based cross-sectional study was conducted on 340 cervical cancer-screened women in three hospitals of East Gojjam from February to April 2020. Data were collected by six BSc-qualified nurses who were working in the selected hospitals. EpiData Manager and SPSS 26 were used for data management and analysis. After the data had been clean, descriptive analysis was done and multivariate logistic regression used to identify predictors of precancerous lesions of the cervix. Statistical significance was taken to be P<0.05.

RESULTS

Of the 340 recruited women, 15.3% (95% CI 11.83%-19.54%) had precancerous cervical lesions. Mean age was 37.11±9.3 years. Age 46-55 (AOR 3.8, 95% CI 1.21-12.47) years, age 56-65 (AOR 12.26, 95% CI 3.18-47.18) years, residing rurally (AOR 2.04, 95% CI 1.12-3.7), prolonged use of oral contraceptive pills (AOR 9.11, 95% CI 1.14-72.8), history of sexual transmitted infection (STI; AOR 3.40, 95% CI 1.32-8.78), HIV-positive status (AOR 4.89, 95% CI 1.54-15.49), and number of lifetime sexual partners (AOR 9.87, 95% CI 1.38-70.4) were important factors associated with precancerous lesions of the cervix.

CONCLUSION

We found relatively high prevalence of precancerous cervical lesions. Age, rural residence, prolonged use of oral contraceptives, STI, multiple sexual partners, and being HIV-positive were important factors associated with precancerous cervical lesions. Women aged >46 years, with a history of STI, being HIV infected, and with a history of multiple sexual partners should be encouraged to get screened for cervical cancer.

Precancerous Cervical Lesions Among HIV-Infected Women Attending HIV Care and Treatment Clinics in Southwest Ethiopia: A Cross-Sectional Study

Background

Despite being one of the few cancers that can be prevented with simple testing, cervical cancer is the fourth most common cancer in women. HIV-positive women showed a median three-fold higher incidence of cervical lesions.

Aim

This study aims to assess the prevalence and factors associated with precancerous cervical lesions among HIV-infected women attending care and treatment clinic in selected hospitals of Southwestern Ethiopia.

Methods

Institution-based cross-sectional study was conducted from February 1 to July 30, 2018. A systematic random sampling technique was employed to select 454 HIV-infected women. Pretested interviewer-administered questionnaire and medical record review were used for data collection. Visual inspection with Acetic acid was done for participants to detect precancerous cervical lesions. Data were analyzed by SPSS version 20. Binary and multiple logistic regression analyses were done. The presence and strength of association were determined using AOR with its 95% CI. Variables with a P value of less than 0.05 were considered as statistically significant.

Results

The prevalence of precancerous cervical lesion was 18.7% [95% CI; (15.1–22.4%)]. Currently, not being on highly active antiretroviral treatment [AOR= 2.31, 95% CI: 1.23–4.39], age (20–29 years) [AOR= 0.185, 95% CI: 0.036,0.939], has no history of sexually transmitted infection [AOR=0.026, 95% CI: 0.006–0.116], has no history of genital wart [AOR= 0.261, 95% CI: 0.073–0.934] and having one lifetime sexual partner [AOR=0.133, 95% CI: 0.024–0.726] were found to be significantly associated with precancerous cervical lesion.

Conclusion

The prevalence of Precancerous Cervical lesion was found to be high in this study. Expansion of screening services and undertaking preventive measures against sexually transmitted infection need to be emphasized.

Alcohol consumption increases non-adherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda

Background

Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV). Community-based ART delivery model offers a decentralized and patient-centered approach to care for PLHIV, with the advantage of improved adherence to ART hence good treatment outcomes. However, data are limited on the magnitude of non-adherence to ART among PLHIV enrolled to the community-based ART model of care. In this study, we determined the frequency of non-adherence to ART and the associated factors among PLHIV enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda.

Methods

This analytic cross-sectional study randomly sampled participants from 21 community drug distribution points at the AIDS Support Organization (TASO) in Gulu district, northern Uganda. Data were collected using a standardized and pre-tested questionnaire, entered in Epi-Data and analyzed in Stata at univariate, bivariate, and multivariate analyses levels. Binary logistic regression analysis was used to determine factors independently associated with non-adherence to ART, reported using odds ratio (OR) and 95% confidence level (CI). The level of statistical significance was 5%.

Results

Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted (aOR), 3.24; 95% CI, 1.24–8.34). Other factors namely being single/or never married (aOR, 1.97; 95% CI, 0.62–6.25), monthly income exceeding 27 dollars (aOR, 1.36; 95% CI, 0.52–3.55), being on ART for more than 5 years (aOR, 0.60; 95% CI, 0.23–1.59), receipt of health education on ART side effects (aOR, 0.36; 95% CI, 0.12–1.05), and disclosure of HIV status (aOR, 0.37; 95% CI, 0.04–3.20) were not associated with non-adherence in this setting.

Conclusion

Non-adherence to ART was low among PLHIV enrolled to community-based ART delivery model but increases with alcohol consumption. Accordingly, psychosocial support programs should focus on alcohol consumption.

Abnormal cervical cytology amongst women infected with human immunodeficiency virus in Limpopo province, South Africa

Background

Cervical cancer remains the major public problem worldwide and the most common gynaecological malignancy in the developing world, particularly in sub-Saharan Africa.

Aim

To determine the prevalence of abnormal cervical cytology amongst women with and without human immunodeficiency virus (HIV) and examine the association between HIV and histological grading.

Setting

The study was conducted in Limpopo province, which is the northernmost province of South Africa. The province has five district municipalities with one tertiary, five regional and thirty four district hospitals.

Methods

We retrospectively reviewed cervical cancer cases in Limpopo province (LP) of South Africa, using data collected routinely by the National Health Laboratory Services (NHLS). The data on smears submitted for cytology between 2013 and 2015 were extracted from the Central Data Warehouse (CDW) database.

Results

A total of 84 466 women were screened for cervical cytology smears. Their mean age was 39.8 ± 13.6 years, with range from 15 to 113 years; 77.2% were in the age group 30 years and older and 19.6% had an abnormal cervical cytology result. Overall, 46.4% of the women screened for cervical cancer were HIV infected. A significantly higher proportion of HIV-positive women had abnormal cytology than HIV-negative women (31.8% vs. 9.2%).

Conclusion

The prevalence of abnormal cytology amongst HIV-positive women is relatively high, and the risk appears to be significantly greater in all age groups. This finding highlights the need to ascertain HIV status of all women presenting with cervical cancer.

Magnitude and associated factors of VIA positive test results for cervical cancer screening among refugee women aged 25-49 years in North Ethiopia

BACKGROUND

Worldwide cervical cancer is the third most common malignancy in women. It usually arises from the cervical area which is susceptible to Human Papilloma virus induced malignancy changes. In low-resource setting visual inspection with acetic acid (VIA) is an alternative sensitive cervical screening method. Therefore the aim of this study was to assess the magnitude and associated factors of VIA positive test results for Cervical Cancer screening among Eritrean refugee women aged 25-49 years in northern Ethiopia refugee camps.

METHODS

A community based cross-sectional study was conducted among 412 Eritrean refugee women aged 25-49 years from august 10 to September 25, 2018. Study subjects were selected by simple random sampling method. Data were collected using pretested structured questioner through Face-to-face interview and cervical examination. Data were coded and entered to Epi info software version 7 and then exported to Statistical package for Social Science (SPSS) version 21 for analysis. Bivariable and multivariable logistic regression analysis was made to test the association between the independent variables and the outcome variable. P-value of less than 0.05 with 95% CI was considered to declare statistical significance.

RESULT

In this study the magnitude of VIA positive precancerous cervical lesions was 9% (95% CI: 6.3-11.8%). Previous history of sexually transmitted infections (STI) [AOR (95%CI) = 2.84(1.07-7.53)] and presence of STI during cervical examination [AOR (95%CI) =3.97(1.75-9.00)] were found significantly associated with VIA positive precancerous cervical lesions.

CONCLUSIONS

In this study the magnitude of VIA positive precancerous cervical lesions was high. Previous history of sexually transmitted infections (STI) and presence of STI during cervical examination were found associated with VIA positive precancerous cervical lesions. Efforts such as early screening for sexually transmitted disease shall be done to prevent precancerous cervical lesions.

Determinants of VIA Positivity Among Women Screened for Cervical Precancerous Lesion in Public Hospitals of Oromia Region, Ethiopia: Unmatched Case-Control Study

Purpose

Globally, cervical cancer is the fourth most frequent cancer among women. An estimated 570,000 cases of cervical cancer representing 6.6% of all female cancers were reported in the year 2018. Approximately, 90% of deaths from cervical cancer occurred in low- and middle-income countries. Screening cervical cancer at an early stage and providing access to effective treatment can significantly improve the likelihood of survival. Hence, this study aimed to assess the determinants of visual inspection of cervix with acetic acid (VIA) positivity among women screened in public hospitals of Oromia region, Ethiopia.

Methods

A hospital-based un-matched case-control study was conducted in Oromia region, Ethiopia. Cases were women who have a positive result for the VIA test, and controls were women with a negative result. An interviewer-administered questionnaire was used to collect the data. Multiple binary logistic regressions were conducted to assess the determinants of VIA positivity. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported to describe the strength of associations. Statistical significance was declared at a p-value <0.05.

Results

A total of 74 cases and 148 controls were included in this study. The mean age of cases and controls was 40.5 ± 13.3 years and 37.1 ± 11.9 years, respectively. Women with parity of four or more children had two times higher odds being positive for VIA test compared to their counterparts (AOR: 2.1, 95% CI: 1.3–4.0). Women with a history of post-coital bleeding had three times higher odds of VIA positivity compared to their counterparts (AOR: 3.3, 95% CI: 1.2–8.0). History of sexually transmitted infection (AOR: 1.9, 95% CI: 1.1–3.5), having multiple sexual partners (AOR: 3.2, 95% CI: 1.2–8.0), and history of smoking (AOR: 8.9, 95% CI: 1.6–48.0) were also found to be determinants of VIA positivity.

Conclusion

This study found that women with parity greater than four children, post-coital bleeding, history of sexually transmitted infections, having multiple sexual partners, and history of smoking were significantly associated with VIA positivity. Women with the mentioned characteristics should be encouraged to have a close follow-up for the screening. Additionally, awareness creation activities on the identified risk factors are strongly recommended for all women.

Precancerous Cervical Lesion Among HIV-Positive Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

In sub-Saharan Africa, cervical cancer is an intersecting epidemic with HIV and it is the second most common cause of cancer-related deaths in women. Therefore, this study was aimed to estimate the current status of the prevalence and associated factors of precancerous cervical lesions among HIV-positive women in sub-Saharan Africa. A systematic literature search was conducted from legitimate electronic databases, including MEDLINE (Ovid), PubMed, EMBASE (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), Web of Science, Scopus, and PopLine and other gray literature including Google, Google Scholar, World Cat, ResearchGate, and Mednar. Data were extracted with a structured format prepared in Microsoft Excel. Each study was evaluated using the Joanna Briggs Institute critical appraisal tool for cross-sectional and cohort studies checklists. Accordingly, medium and high-quality studies were included in the review. Data synthesis and statistical analysis was conducted using OpenMeta and comprehensive meta-analysis version 2 software. The study protocol is registered on PROSPERO with ID: CRD42018114266. The pooled prevalence of precancerous cervical lesion among HIV-positive women in sub-Saharan Africa was 25.6% (95% confidence interval [CI]: 19.4%-31.8%). Having more than 2 lifetime sexual partners (odds ratio [OR]: 4.77; 95% CI: 1.35-16.93), having had a history of sexually transmitted infections (STIs; OR: 1.92; 95% CI: 1.03-3.57), having more than 2 births (OR: 1.84; 95% CI: 1.33-2.53), and CD4 count <200 cells/mm3 (OR: 1.765; 95% CI: 1.23-2.535) were significantly associated with precancerous cervical lesions. The prevalence of precancerous cervical lesion among HIV-positive women was high. One in 4 HIV-infected women suffers from precancerous cervical lesion. Lower CD4 cell count, STIs, multiple sexual partnering, and histories of multiple births and abortions were the foremost contributing factors for this burden. Precancerous cervical lesion could be reduced significantly if preventive and promotive measures are done on the associated factors.