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Agaba CD, Namuli A, Ainomugisha B, Tibaijuka L, Ninsiima M, Ngonzi J, Akatukwasa C, Owaraganise A. Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study. BMC Womens Health 2024; 24:392. [PMID: 38978020 PMCID: PMC11229203 DOI: 10.1186/s12905-024-03239-0] [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: 08/27/2023] [Accepted: 06/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death. OBJECTIVE We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda. METHODS In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis. RESULTS The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake. CONCLUSION Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.
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Affiliation(s)
- Collins David Agaba
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexcer Namuli
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Brenda Ainomugisha
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mackline Ninsiima
- Department of Epidemiology, School of Public Health, Makerere College of Health Sciences, Kampala, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Asiphas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
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Descamps P, Dixon S, Bosch Jose FX, Kyrgiou M, Monsonego J, Neisingh O, Nguyen L, O'Connor M, Smith JS. Turning the tide-Recommendations to increase cervical cancer screening among women who are underscreened. Int J Gynaecol Obstet 2024; 166 Suppl 1:3-21. [PMID: 38853590 DOI: 10.1002/ijgo.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Philippe Descamps
- Co-Chair, ACCESS Consensus Group, Professor and Chairman, Department of Obstetrics and Gynecology, University Hospital Angers, Former Vice President of FIGO, and President of International Relations Committee, CNGOF (French College of Obstetricians and Gynecologists), Angers, France
| | - Samantha Dixon
- Former Co-Chair, ACCESS Consensus Group, Former CEO, Jo's Cervical Cancer Trust, London, UK
| | - Francesc Xavier Bosch Jose
- Clinical Oncologist, Epidemiologist, Co-founder, HPV Information Center (ICO and IARC), Director, HPV World (HPW), Barcelona, Spain
| | - Maria Kyrgiou
- Consultant Surgeon in Gynecology and Gynecological Oncology, Imperial College London, London, UK
| | - Joseph Monsonego
- Gynecologist-Oncologist, Founding President of EUROGIN, President of 1000 Femmes 1000 Vies Patient Association, Paris, France
| | - Ody Neisingh
- Independent Consultant and Public Affairs Advisor, with Extensive Working Experience at WOMEN Inc. and UN Women, and Member of the European Economic and Social Committee on behalf of Gender Equality Civil Society, Amsterdam, The Netherlands
| | - Lananh Nguyen
- Director of Cytopathology and Assistant Professor, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mairead O'Connor
- Research Officer, National Screening Service Ireland, Dublin, Ireland
| | - Jennifer S Smith
- Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Mkuu RS, Staras SA, Chakrabarti C, Hall J, Harvey I, Salloum RG, Barrow S, Ortega S, Woodard J, Seals K, Rawls A, Meduri Y, Donahoo WT, Goede DL, Shenkman EA. Acceptability of HPV self-collection: A qualitative study of Black women living with type II diabetes and social vulnerability. J Clin Transl Endocrinol 2024; 35:100331. [PMID: 38444842 PMCID: PMC10912756 DOI: 10.1016/j.jcte.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Human papillomavirus (HPV) causes 99.7% of cervical cancer cases. Cervical cancer is preventable through early detection via HPV testing. However, the number of women screened for cervical cancer has not increased in the last several years. Lower screening rates among women living in high poverty and social vulnerability areas, Black women, and women with chronic co-morbidities (e.g., type 2 diabetes (T2D)) are associated with their higher cervical cancer mortality rates. When screened, Black women are more likely to be diagnosed at later stages and die from cervical cancer. HPV self-collection decreases barriers to cervical cancer screening and can help lessen disparities among underserved women. This study aimed to examine the acceptability of HPV self-collection among Black women with T2D living in socially vulnerable communities. Methods Qualitative semi-structured interviews were conducted with 29 Black women with T2D living in communities with high social vulnerability. The Health Belief Model informed the development of the interview guide to gather data on the acceptability of HPV self-collection. Results Three main themes aligned with the Health Belief Model were identified: (1) HPV self-collection provides a comfortable alternative to in-clinic HPV testing (perceived benefits); (2) HPV self-collection would result in awareness of current HPV status (health motivation); and (3) Women were concerned about collecting their sample accurately (perceived barriers). Discussion/Conclusion Black women with T2D living in communities with high social vulnerability identified multiple benefits of cervical cancer screening through HPV self-collection. Women are concerned about their ability to collect these samples correctly. Our findings call for future studies focusing on increasing self-efficacy and skills to collect HPV samples among Black women with chronic conditions like T2D who reside in underserved communities with high social vulnerability.
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Affiliation(s)
- Rahma S Mkuu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Stephanie A Staras
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Choeeta Chakrabarti
- Department of Anthropology, Florida State University, 909 Antarctic Way, Tallahassee, FL 32304, USA
| | - Jaclyn Hall
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Idethia Harvey
- College of Health Sciences, University of Missouri, 313 Clark Hall, Columbia, MO 65211, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Sable Barrow
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Selena Ortega
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Jennifer Woodard
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Office of Community Outreach and Engagement, UF Health Cancer Center, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - Kayla Seals
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Audrey Rawls
- Department of Health Science, University of Alabama, 108 Russell Hall, Tuscaloosa, AL 35487, USA
| | - Yashaswini Meduri
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
| | - William T Donahoo
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, P.O. Box 100226, Gainesville, FL 32610, USA
| | - Dianne L Goede
- Internal Medicine, College of Medicine, University of Florida, 1549 Gale Lemerand Drive, 4th Floor, Suite 4592, Gainesville, FL 32610-3008, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, 1889 Museum Rd, 7th Floor, Suite 7000, Gainesville, FL 32611, USA
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Mitoma T, Maki J, Ooba H, Ogawa C, Masuyama H, Tabuchi T. Association of Regular Cervical Cancer Screening with Socioeconomic, COVID-19 Infection and Vaccine Status Among Japanese Population: Cohort Observational Study. Int J Gen Med 2024; 17:541-551. [PMID: 38371520 PMCID: PMC10874123 DOI: 10.2147/ijgm.s453675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Among the Organisation for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening coverages. Cancer screening coverage has worsened due to the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the relationship between socioeconomic background, COVID-19 infection history and vaccine status, and regular cervical cancer screening (CCS) during the two years of the COVID-19 era in Japan. Patients and Methods We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, Internet-based, self-report cohort observational study conducted in 2022. The outcome variable was identified by asking whether the participants had undergone CCS within the last two years. Cervical cytology was performed in Japan by brushing the external cervical os. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate the socioeconomic background variables. Results Of the 12,066 participants, 5597 (46.4%) had undergone regular CCS for over two years. The prevalence ratio (PR) of patients who underwent CCS was 0.70 for those in their 20s and 0.78 for those in their 60s, compared to those in their 40s. Socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million Yen. Our final multivariate analysis revealed that participants who were in their 20s or 60s, had a household income below 4 million Yen, were unmarried, had no annual health check-ups, and were unvaccinated with COVID-19 were at a higher risk of not undergoing CCS. Conclusion The relationship between socioeconomic inequality and CCS hesitancy is prevalent among younger participants. The CCS coverage in Japan during the COVID-19 pandemic year (2020-2022) was not low compared with the pre-pandemic era.
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Affiliation(s)
- Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hikaru Ooba
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Chikako Ogawa
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Tabuchi
- Department of Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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