Predictors of cervical cancer screening intention of HIV-positive women in the central region of Ghana

"ARVs is for HIV and cream is for HPV or precancer:" Women's Perceptions and Perceived Acceptability of Self-Administered Topical Therapies for Cervical Precancer Treatment: A Qualitative Study from Kenya

Background

Women in low- and middle-income countries (LMICs) bear a disproportionate burden of global incidence and deaths from cervical cancer, despite being a preventable disease. Prevention efforts in LMICs are hindered in part by lack of access to cervical precancer treatment, due to weak health infrastructure and a lack of adequate human resources to deliver current provider-administered precancer treatments. Innovative strategies are urgently needed to close the cervical precancer treatment gap in LMICs, including the use of self-administered topical therapies for which efficacy evidence is available from high-income settings. We investigated African women's perceptions and perceived acceptability of these therapies for cervical precancer treatment.

Methods

Between November 2022 and April 2023, we conducted five focus group discussions (FGDs) with women ages 25-65 years undergoing cervical cancer screening or precancer treatment in Kisumu, Kenya. The FGDs explored women's experiences with screening and precancer treatment, their acceptability of topical therapies for precancer treatment, and perceived barriers and facilitators to uptake. The FGDs were moderated by local qualitative research assistants, conducted in local languages, transcribed, coded, and analyzed using qualitative description using NVIVO software.

Results

Twenty-nine women participated, with a mean age of 35.4 years (SD 6.5). All had undergone cervical cancer screening, and 25 (83%) had a history of precancer treatment with ablation or excision. Multiple themes were identified related to women's perceptions of topical therapies. Participants were highly receptive of topical treatments, with many favoring the option of self-administration compared to provider-administration of such therapies. Self-administration of topical therapies was felt to help address challenges associated with current treatment methods, including difficulty in access, pain with procedures, cost, and lack of privacy with pelvic exams. Participants had a preference for topical therapies that are used less frequently compared to those used daily.

Conclusions

Among Kenyan women with a history of cervical precancer treatment, self-administered topical therapies for precancer are acceptable and have the potential to address barriers, including access, privacy, and cost, that hinder precancer treatment in LMICs. If supported by efficacy studies in LMICs, self-administered topical therapies offer a scalable approach to closing the precancer treatment gap in LMICs.

Trial registration

Not applicable.

Does Prior Experience Matter? Intention to Undergo Cervical Cancer Screening among Rural Women in South-Central Ethiopia

Early screening for cervical cancer has substantially reduced the morbidity and mortality attributed to it. This study aimed to assess factors that affect the intention to undergo cervical cancer screening among rural women attending primary healthcare facilities in south-central Ethiopia. A health-facility-based, cross-sectional study design was employed for which the calculated required sample size was 427. An interviewer-administered structured questionnaire was adapted from previously published research and used to collect data. Statistical Package for Social Sciences (SPSS) version 27 was used for the statistical analysis. A logistic regression model was used to determine the factors that influenced the women's intention to undergo cervical cancer screening. A total of 420 women participated in this study, with a response rate of 98%. The mean score from the questionnaire that was used to assess the women's intention to undergo cervical cancer screening was 10.25 (SD ± 2.34; min 3, max 15). The absence of previous screening experience (AOR: 0.498; 95% CI 0.27-0.92) and high degree of perceived behavioural control (AOR, 0.823; 95% CI 0.728-0.930) were significantly negatively associated with women's intention to undergo cervical cancer screening. Previous screening experience and perceived behavioural control significantly influenced the intention to undergo cervical cancer screening. Women in rural areas could, therefore, benefit from awareness-creation programmes that focus on these factors.

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.

HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening

INTRODUCTION

Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV.

OBJECTIVES

This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana.

METHODS

Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana.

RESULTS

Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive).

CONCLUSIONS

There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.

Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model

BACKGROUND

Women living with HIV are at increased risk of developing cervical cancer (CC). Screening for cancer is an important preventive strategy for the early detection of precancerous lesions and its management. There has been inadequate evidence on cervical cancer screening (CCS) practices among HIV-positive women in rural western Uganda. This study aimed to assess the prevalence and predictors of CCS among HIV-positive women, as well as knowledge and practices regarding cervical cancer screening.

METHODS

A cross-sectional, analytical study was conducted among HIV-positive women attending HIV care facilities located in rural settings of western Uganda. A validated and interview-based data collection form was used to capture statistics regarding demographics, HIV care, obstetric profile, health belief constructs, and knowledge and history of CCS from the participants. Bivariate and multivariate logistic regression analyses were used to correlate women's characteristics and health beliefs toward CCS practices.

RESULTS

The prevalence of CCS among HIV-positive women was found to be 39.1% (95%CI: 14.0-71.7). A multivariate logistic regression analysis showed that post-secondary education attainment (AOR = 3.21; 95%CI = 2.12-7.28), four years or more lapsing after being diagnosed as HIV-positive (AOR = 2.87; 95%CI = 1.34-6.13), having more than one child (AOR = 1.87; 95%CI = 1.04-3.35), antenatal care attendance (AOR = 1.74; 95%CI = 1.02-3.43), post-natal care attendance (AOR = 3.75; 95%CI = 1.68-5.89), and having good knowledge regarding CC (AOR = 1.26; 95%CI = 1.98-3.02) were positively associated with adherence to CCS among HIV-positive women in western Uganda. Health Belief Model (HBM) constructs like the perceived risk of developing CC (AOR = 1.82; 95%CI = 1.16-2.01), worries about developing CC (AOR = 5.01; 95%CI = 4.26-8.32), believing that CC leads to death (AOR = 2.56; 95%CI = 1.64-3.56), that screening assists in early identification (AOR = 2.12; 95%CI = 1.84-3.74) and treatment (AOR = 4.63; 95%CI = 2.78-6.43) of precancerous lesions, reducing the risk of mortality (AOR = 1.84; 95%CI = 1.12-2.75), and the reassurance provided by negative test results (AOR = 2.08; 95%CI = 1.33-4.22) were positively associated with adhering to CCS. A female doctor performing the screening (AOR = 2.02; 95%CI = 1.57-3.98) as well as offering a free screening service (AOR = 3.23; 95%CI = 1.99-4.38) were significantly associated with CCS. Meanwhile, screening being painful (AOR = 0.28; 95%CI = 0.12-0.45), expensive (AOR = 0.36; 95%CI = 0.24-0.53), time-consuming (AOR = 0.30; 95%CI = 0.19-0.41), embarrassing (AOR = 0.02; 95%CI = 0.01-0.06), and the fear of positive results (AOR = 0.04; 95%CI = 0.02-0.10) were found to have a significant negative association with adhering to CCS.

CONCLUSIONS

Only one-third of HIV-positive women had undergone CCS. Variables including secondary education attainment, four years or more lapsing after being diagnosed as HIV-positive, having more than one child, antenatal care attendance, post-natal care attendance, and knowledge about CC were positively associated with CCS adherence. Educational programs should be geared towards the risk of CC, severity of cases, benefits of screening, and reducing barriers associated with screening, which can significantly improve cervical CCS among HIV-positive women. The study proposes the incorporation of free screening services and the inclusion of trained female staff in CC prevention policies to improve CCS.

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.

High-risk human papillomavirus genotype distribution among women living with HIV; implication for cervical cancer prevention in a resource limited setting

BACKGROUND

For women living with HIV (WLHIV), the burden of persistent HPV infection, cervical pre-cancerous lesions and cancer have been demonstrated to be higher than among HIV-negative women. As Ghana and other lower-middle-income countries (LMIC) work toward developing national cervical cancer programmes, it is essential that local scientific evidence be provided to guide policy decisions, especially for such special populations. The objective of this study was to determine the distribution of high-risk HPV genotype and related factors among WLHIV and its implication for the prevention of cervical cancer prevention efforts.

METHODS

A cross-sectional study was conducted at the Cape Coast Teaching Hospital in Ghana. WLHIV, aged 25-65 years, who met the eligibility criteria were recruited through a simple random sampling method. An interviewer-administered questionnaire was used to gather socio-demographic, behavioural, clinical and other pertinent information. The AmpFire HPV detection system (Atila BioSystem, Mointain View, CA was used to detect 15 high-risk HPV genotypes from self-collected cervico-vaginal samples. The data collected were exported to STATA 16.0 for statistical analysis.

RESULTS

In all, 330 study participants, with mean age of 47.2 years (SD ± 10.7), were involved. Most (69.1%, n = 188/272) had HIV viral loads < 1000 copies/ml and 41.2% (n = 136) had ever heard of cervical screening. The overall hr-HPV prevalence was 42.7% (n = 141, 95% CI 37.4-48.1) and the five commonest hr-HPV types among screen positives were HPV59 (50.4%), HPV18 (30.5%), HPV35 (26.2%), HPV58 (17%) and HPV45 (14.9%). Most infected women (60.3%, n = 85) had multiple hr-HPV infections, with about 57.4% (n = 81) having 2-5 h-HPV types, while 2.8% (n = 4) had more than five hr-HPV types. A total of 37.6% (n = 53) had HPV16 and/or18, while 66.0% (n = 93) had the hr-HPV genotypes covered by the nonavalent vaccine. Women with HIV viral load ≥ 1000copies/ml (AOR = 5.58, 95% CI 2.89-10.78, p < 0.001) had a higher likelihood of being co-infected.

CONCLUSION

This study found out that the prevalence of hr-HPV still remains high in women with HIV, with a notable occurrence of multiple infections and infection with genotypes 16 and/or18. Additionally, an association was established between hr-HPV and infection HIV viral load.. Therefore, comprehensive HIV care for these women should include awareness of cervical cancer, consideration of vaccination and implementation of screening and follow-up protocols. National programmes in LMIC, such as Ghana, should consider using HPV-based screen-triage-treat approach with partial genotyping.

Acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women: a mixed methods study at Mbarara Regional Referral Hospital, Uganda

BACKGROUND

Integrating cervical cancer screening into routine Human Immunodeficiency Virus (HIV) care has been endorsed as an effective strategy for increasing uptake of cervical cancer screening, facilitating early detection and treatment of pre-cancerous lesions among HIV-infected women. In Uganda, this strategy has not been implemented yet in most HIV clinics. Assessing acceptability of this intervention among HIV-infected women is of great relevance to inform implementation. We assessed acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women enrolled in the HIV clinic at Mbarara Regional Referral Hospital.

METHODOLOGY

A mixed methods study utilizing explanatory sequential approach was conducted among 327 eligible HIV-infected women. Acceptability of integration of cervical cancer screening into routine HIV care was measured based on Theoretical Framework of Acceptability. Quantitative data was collected using a pre-tested questionnaire. We conducted focus group discussions to explore perceptions regarding the intervention among purposively selected HIV-infected women. Modified Poisson regression with robust variance analysis was utilized to determine factors associated with acceptability of the intervention. Statistical significance was determined at p-value <0.05. Thematic analysis utilizing inductive coding was applied to analyse qualitative data.

RESULTS

The majority of HIV-infected women (64.5%) accepted integration of cervical cancer screening into routine HIV care. Religion, perceived risk of developing cervical cancer and ever screened for cervical cancer were statistically significantly associated with acceptability of integration of cervical cancer screening into routine HIV care. Perceived benefits of the proposed intervention were: convenience to seek for cervical cancer screening, motivation to undergo cervical cancer screening, improved archiving of cervical cancer screening results, confidentiality of HIV patient information, and preference to interact with HIV clinic health workers. Shame to expose their privacy to HIV clinic health workers and increased waiting time were the only perceived challenges of the integrated strategy.

CONCLUSION

Study findings highlight the need to take advantage of this acceptability to prioritize implementation of integration of cervical cancer screening into routine HIV care. HIV-infected women should be reassured of confidentiality and reduced waiting time to increase uptake of integrated cervical cancer screening and HIV services among HIV-infected women along the continuum of HIV care and treatment services.

Cervical Cancer: Early Detection and Prevention in Reproductive Age Group

Cancer has been one of the major illnesses faced by people over many generations. Despite the advancements made in medicine, there are still many problems faced by humankind. Every year a large number of people are diagnosed with cervical cancer. It is the most common type of cancerous condition prevalent among females, especially females over thirty years of age. Like any other cancer, cervical cancer also occurs because of the rapid uncontrolled division of the body cells. A primary reason for its development is the longstanding infection of certain types of human papillomavirus (HPV). A screening test is done to confirm the presence of the virus in the cervix. Many screening tests are available today for accurate diagnosis or confirmation of the condition being suffered from. The main goal of screening is early detection and making certain lifestyle changes to deduce the potential harm of the disease and start the treatment as soon as possible. A thorough study of the already published articles by scholars, professors, and doctors is carried out to conclude the necessity of cervical cancer screening and early detection.

Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi

BACKGROUND

Cervical cancer is a prevalent public health concern and is among the leading causes of death among women globally. Malawi has the second highest cervical cancer prevalence and burden in the world. Due to the cervical cancer burden, the Malawi government scaled up national cancer screening services in 2011, which are free for all women. This paper is the first study to examine the socioeconomic inequality in cervical cancer screening uptake using concentration indices, in Malawi. Furthermore, it decomposes the concentration index to examine how each factor contributes to the level of inequality in the uptake of cervical cancer screening.

METHODS

The data used in this paper were obtained from the nationally representative Malawi Population HIV Impact Assessment (MPHIA) household survey, which was conducted in 2015. Concentration curves were constructed to explore whether there was any socioeconomic inequality in cervical cancer screening and, if so, its extent. This was complemented by concentration indices that were computed to quantify the magnitude of socioeconomic inequality. A decomposition analysis was then conducted to examine the factors that explained/were associated with greater socioeconomic inequality in cervical cancer screening. The methodology in this paper followed that of previous studies found in the literature and used the wealth index to measure socioeconomic status.

RESULTS

The results showed that the concentration curves lay above the line of equality, implying a pro-rich inequality in cervical cancer screening services. Confirming the results from the concentration curves, the overall concentration index was positive and significant (0.142; %95 CI = 0.127, 0.156; p < 0.01). The magnitude was lower in rural areas (0.075; %95CI = 0.059, 0.090; p < 0.01) than in urban areas (0.195; %95CI = 0.162, 0.228 p < 0.001). After undertaking a decomposition of the concentration index, we found that age, education, rural or urban location, and wealth status account for more than 95% of the socioeconomic inequality in cervical cancer uptake.

CONCLUSION

Despite the national scale-up of free cancer care at the point of use, cervical cancer screening uptake in Malawi remains pro rich. There is a need to implement parallel demand-side approaches to encourage uptake among poorer groups. These may include self-testing and mobile screening centres, among others.

The Effect of Social Norms on Physicians’ Intentions to Use Liver Cancer Screening: A Cross-Sectional Study Using Extended Theory of Planned Behavior

Background

Liver cancer is a globally acknowledged threat to public health, and there is a critical and urgent need to determine factors associated with the use of liver cancer screening and to further promote its use.

Purpose

To examine whether the extended theory of planned behavior (TPB) incorporating social norms predicts physicians’ intentions to use liver cancer screening and to identify the associated factors quantitatively, using contrast-enhanced ultrasound (CEUS) as an example.

Methods

A research framework was established by adding social norms to the TPB, based on which the questionnaire for this study was developed. Through multistage random sampling, a cross-sectional questionnaire survey was conducted among 292 physicians in Fujian and Jiangxi provinces. Due to the multicollinearity problem of the data, ridge regression was applied to determine the influencing factors of physicians’ intentions to use CEUS.

Results

Most participants (87.30%) reported that they were willing to use liver cancer screening in their clinical practice. The scores of TPB variables were generally higher than those of social norms variables. Ridge regression results indicated that the proposed model was explanatory, which has accounted for 73.5% of the total variance in physicians’ intentions. Analyses also illustrated the significant role of TPB variables (attitude and perceived behavioral control) and social norms variables (personal norms, organizational norms, and industrial norms) on physicians’ intentions to use CEUS.

Conclusion

The study extended the TPB by including the concepts of social norms, which is not only conducive to expanding the knowledge of factors associated with physicians’ intentions to use liver cancer screening, but also provides implications for developing strategies to promote the use of certain health services or products, such as playing the role of core members, holding panel meetings, and establishing information push systems.

Using Multilevel Structural Equation Modeling (MSEM) to Identify the Predictors and Influencing Mechanism of Technology Use Among Chinese Physicians: An Example from Des-Gamma-Carboxy Prothrombin (DCP)

Background

Since expanding the use of appropriate and effective health technologies will greatly benefit the diagnosis and treatment of some major diseases at an early stage, understanding the mechanism of technology use is crucial for its successful implementation. Few previous studies focused on the healthcare providers and involved multi-facets factors at individual, technical, organizational, and environmental levels.

Purpose

To examine the influencing mechanism of technology use among Chinese physicians by integrating multilevel factors, Des-gamma-Carboxy Prothrombin (DCP) was taken as an example.

Methods

Through multistage random sampling, a cross-sectional questionnaire survey was conducted among physicians in charge of direct use of DCP of sampled secondary and tertiary hospitals. Since the sample data comprised two hierarchical levels (physicians and hospitals), multilevel structural equation modeling was used to link five aspects of factors with physicians’ technology use and estimate the effects.

Results

Totally, 229 physicians completed the investigation. The use of DCP appears to be at a relatively low level. Intra-class coefficients of the null model (unadjusted baseline model) suggested that physicians’ DCP use has a significant variation between hospitals. The final model identified that value cognition (B = 0.447, P < 0.01), experienced organizational practice (B = 0.203, P < 0.05), and perceived organizational atmosphere (B = −0.237, P < 0.01) contributed directly to physicians’ DCP use. Additionally, technical assessment, perceived organizational atmosphere, and perceived environmental pressure had indirect impacts on physicians’ DCP use that were mediated by value cognition and experienced organizational practice (P < 0.05).

Conclusion

This study incorporated and determined the significant direct or indirect role of value cognition, technical assessment, experienced organizational practice, perceived organizational atmosphere, and perceived environmental pressure. This influencing mechanism with integrated multilevel factors could serve as a theoretical basis for tailoring interventions to promote technology use among Chinese physicians.

Cervical cancer screening utilization and predictors among eligible women in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Despite a remarkable progress in the reduction of global rate of maternal mortality, cervical cancer has been identified as the leading cause of maternal morbidity and mortality, particularly in sub-Saharan African countries. The uptake of cervical cancer screening service has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. Despite this, there are limited studies in Ethiopia that were conducted to assess the uptake of cervical cancer screening and its predictors, and these studies showed inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis was conducted to estimate the pooled cervical cancer screening utilization and its predictors among eligible women in Ethiopia.

METHODS AND FINDINGS

Databases like PubMed, Web of Science, SCOPUS, CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library were systematically searched. All observational studies reporting cervical cancer screening utilization and/ or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. Quality assessment criteria for prevalence studies were adapted from the Newcastle Ottawa quality assessment scale. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of studies. A random effects model of analysis was used to estimate the pooled prevalence of cervical cancer screening utilization and factors associated with it with the 95% confidence intervals (CIs). From 850 potentially relevant articles, twenty-five studies with a total of 18,067 eligible women were included in this study. The pooled national cervical cancer screening utilization was 14.79% (95% CI: 11.75, 17.83). The highest utilization of cervical cancer screening (18.59%) was observed in Southern Nations Nationalities and Peoples' region (SNNPR), and lowest was in Amhara region (13.62%). The sub-group analysis showed that the pooled cervical cancer screening was highest among HIV positive women (20.71%). This meta-analysis also showed that absence of women's formal education reduces cervical cancer screening utilization by 67% [POR = 0.33, 95% CI: 0.23, 0.46]. Women who had good knowledge towards cervical screening [POR = 3.01, 95%CI: 2.2.6, 4.00], perceived susceptibility to cervical cancer [POR = 4.9, 95% CI: 3.67, 6.54], severity to cervical cancer [POR = 6.57, 95% CI: 3.99, 10.8] and those with a history of sexually transmitted infections (STIs) [POR = 5.39, 95% CI: 1.41, 20.58] were more likely to utilize cervical cancer screening. Additionally, the major barriers of cervical cancer screening utilization were considering oneself as healthy (48.97%) and lack of information on cervical cancer screening (34.34%).

CONCLUSIONS

This meta-analysis found that the percentage of cervical cancer screening among eligible women was much lower than the WHO recommendations. Only one in every seven women utilized cervical cancer screening in Ethiopia. There were significant variations in the cervical cancer screening based on geographical regions and characteristics of women. Educational status, knowledge towards cervical cancer screening, perceived susceptibility and severity to cervical cancer and history of STIs significantly increased the uptake of screening practice. Therefore, women empowerment, improving knowledge towards cervical cancer screening, enhancing perceived susceptibility and severity to cancer and identifying previous history of women are essential strategies to improve cervical cancer screening practice.

Women diagnosed with HIV and unknown HIV status perceived susceptibility to cervical cancer and perceived benefits of cervical cancer screening in Ghana: a cross-sectional study

BACKGROUND

Cervical cancer is an issue of global health concern, and it seems to be the next epidemic in Sub-Saharan Africa after Human Immunodeficiency Virus (HIV). This study compared the perceptions of susceptibility to cervical cancer and benefits of cervical cancer screening among women diagnosed and those with unknown HIV status and determined the association between socio-demographic factors and HIV status.

METHODS

A cross-sectional study was conducted with 600 women diagnosed with HIV and 600 women with unknown HIV status in the Central Region of Ghana. Convenience sampling was used and a structured interview schedule was the main data collection instrument. Data were analysed using frequencies, percentages, chi-square test and independent samples t-test.

RESULTS

A high proportion of women diagnosed with HIV 94.8% (n = 569) and those with unknown HIV status 93.5% (n = 561) agreed that "screening can find cervical changes". Also, 58.0% (n = 348) of women diagnosed with HIV agreed that they have been in polygamous relationships so they may get cervical cancer. There was a statistically significant association between marital status (X2 = 167.071, p = 0.001), religion (X2 = 57.720, p = 0.001), level of education (X2 = 118.997, p = 0.001), employment status (X2 = 782.646, p = 0.001) and HIV status. A comparison of the mean difference for women diagnosed and those with unknown HIV status in relation to perceived benefits of cervical cancer screening showed a statistically significant difference (t = 7.418, df = 1198, p = 0.001). Nonetheless, there was no statistically significant difference in the means for women diagnosed and those with unknown HIV status regarding perceived susceptibility to cervical cancer (t = 0.935, df = 1198, p = 0.351).

CONCLUSIONS

Women with HIV perceived higher benefits of cervical cancer screening. Perception of susceptibility to cervical cancer by women with and those without HIV need to be addressed in efforts to improve their health. Furthermore, interventions for women with HIV should consider some important sociodemographic factors.

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.

Nurses' and midwives' knowledge, attitudes, and acceptance regarding human papillomavirus vaccination in Ghana: a cross-sectional study

BACKGROUND

Nurses and midwives play important roles in educating the public on cervical cancer prevention strategies.

AIM

This study sought to assess nurses' and midwives' knowledge of, attitudes towards, and acceptance of human papillomavirus (HPV) vaccination in relation to their background characteristics.

METHODS

A descriptive cross-sectional study using questionnaires was conducted with a convenience sample of 318 female nurses and midwives, ages 20 to 59, at the Korle-Bu Teaching Hospital in Ghana. The data were summarised using frequencies, percentages, chi-square tests, and Fisher's exact tests.

RESULTS

The results indicated that 41.5% (n = 132) of the participants had high levels of knowledge about cervical cancer risk factors, and 17.6% (n = 56) of the respondents had received at least one dose of the HPV vaccine. Reasons for receiving the HPV vaccination included advice from a colleague (12.9%, n = 41) and perceived threat of cervical cancer (11.7%, n = 37). Of the 262 respondents who had not been vaccinated, 24.45% (n = 78) strongly agreed and 28.0% (n = 89) agreed with the statement that there was limited information on HPV vaccination. Also, there were statistically significant associations between age (X2 = 23.746, p = 0.001), marital status (X2 = 14.758, p = 0.005), completed level of education (X2 = 21.692, p = 0.001), and duration of working at the hospital (X2 = 8.424, p = 0.038) and acceptance of HPV vaccination.

CONCLUSIONS

This study demonstrated gaps in knowledge about cervical cancer risk factors and attitudes towards HPV vaccination, indicating the need for targeted measures to improve knowledge and attitudes. Also, measures to increase acceptance of HPV vaccination among nurses and midwives should consider their sociodemographic characteristics.

Cervical Cancer Screening among Women Receiving Antiretroviral Therapy in a Resource-Limited Environment

Background:

Cervical cancer is among the most prevalent cancer among women worldwide and women living with HIV are at increased risk, especially in a resource-limited environment.

Objective:

This study aimed to determine levels of awareness, knowledge, uptake, and willingness to screen for cervical cancer among women receiving care in an HIV clinic at Dodoma Regional Referral Hospital (DRRH), Tanzania.

Methods:

Data were collected for a period of three weeks from July 21 to August 11, 2017 using a mobile phone data collection App. A total of 421 Women aged 18-50 years old were included in the study.

Results:

Majority of the women interviewed (n=306, 73%) were aware of cervical cancer. Among those who were aware, 84% (n=257) did not recall ever being screened for cervical cancer, and majority had a poor knowledge of cervical cancer. Educational level completed (p=0.01), income per month (p=0.02), age group (p<0.0001), and area of residence (p<0.0001) were all significantly associated to awareness of cervical cancer. Most of the women who have never screened (n=231, 91%) expressed willingness to be screened. Prior uptake of cervical cancer screening was associated with number of live births (p=0.001) and area of residence (p=0.04). And Willingness to screen was significantly associated with age groups (p=0.03) and the number of live births (p=0.03). Moreover, we found that younger age and urban residence was positively associated with awareness and uptake of cervical cancer screening. Willingness was found to decrease as age increased.

Conclusion:

The study found that despite older women’s higher risk of cervical cancer, those who indicated willingness to screen were younger. Additional education, health promotion, and integration of cervical cancer screening services is needed to improve cervical cancer awareness and screening uptake at the HIV clinic.

Health Belief, Behavior Intention, and Health Behaviors Related to Colorectal Cancer Screening in Taiwan

Health belief and behavior intention affect subsequent health behaviors. The purpose of this study was to assess the levels of health belief, behavior intention, and health behavior, and to identify the factors related to health behaviors in adults receiving colorectal cancer (CRC) screening in Taiwan. This cross-sectional study recruited patients receiving a CRC screening from the cancer screening outpatient department of a teaching hospital in northern Taiwan. Demographic and health characteristics were recorded, and participants were assessed using Champion’s health belief model scale, cancer screening intention scale, and the health protective behavior scale. Of the 125 subjects (aged 49–75 years), 27.2% reported active screening; the rest passively received screening after doctor referral. Those who were doctor-referred had lower levels of health behavior, including general behavior, self-knowledge, and health care. Positive health behaviors related to CRC screening were associated with not smoking, greater seriousness in health belief, more confidence in health belief, consuming the recommended amount of fruits and vegetables, and motivation for CRC screening; these factors explained 35.0% of the variance in positive health behaviors related to CRC screening. A comprehensive education program encouraging CRC cancer screening should include access to available resources and encourage positive health belief and behavior intention related to this important cancer screening activity.

Patients' self-reported factors influencing cervical cancer screening uptake among HIV-positive women in low- and middle-income countries: An integrative review

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This review reveals barriers of cervical cancer screening among HIV-positive women.

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The uptake of cervical cancer screening among HIV-positive women is very low.

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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.

Predictors of cervical cancer screening practice among HIV positive women attending adult anti-retroviral treatment clinics in Bishoftu town, Ethiopia: the application of a health belief model

BACKGROUND

Cervical cancer is a global public health problem and the second most common cancer causing morbidity and mortality in Ethiopia. Few available evidences revealed that despite distribution and severity of cervical cancer among HIV-positive women and the ease with which it can be prevented, cervical cancer screening practice in Ethiopia among them is considerably low. Thus, this study aims to assess predictors of cervical cancer screening practice among HIV-positive women by applying health belief model concepts.

METHODS

Facility based cross-sectional study was conducted in Bishoftu. Data was collected from 475 women who visit the health facilities for anti-retroviral services using interviewer-administered questionnaires. Champion's revised Health Belief Model sub-scales were used as data collection tools containing sources of information, knowledge, perception on cervical cancer screening and cervical cancer screening practice as variables. Frequencies, percentage, mean and standard deviation were used to describe findings. Multi-variable logistic regression and 95% confidence intervals were considered to identify predictors of cervical cancer screening practice by controlling possible confounders.

RESULTS

Cervical cancer screening practice among HIV-positive women in this study was 25%. Health proffesionals were the main sources of information about cervical cancer and its screening. There was a difference between the 'ever' and 'never' screened groups in mean scores of their perceived severity, perceived benefit, perceived barrier, perceived self-efficacy, perceived threat and net-benefit towards screening (P < 0.05). Perceived self-efficacy (AOR 1.24, 95%CI 1.13-1.37), perceived threat (AOR 1.08, 95%CI 1.05-1.12) and perceived net-benefit (AOR 1.18, 95% CI 1.12, 1.24) were the predictors of cervical cancer screening practice.

CONCLUSIONS

Cervical cancer screening practice in this study was lower than that of the recommended coverage of the target group by the national guideline (80%). This finding has an important implication for public health intervention aimed at cervical cancer prevention. Morever, womens' perceptions on cervical cancer screening had a significant influence on the utilization of cervical cancer screening service. Therefore, educational programmes geared towards severity of the case, availability of screeningand helpfulness of being screened can significantly improve the uptake of cervical cancer screening.