Abstract
Introduction: Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening. Self-collection has the potential to increase the uptake of cervical cancer screening among Cameroon women. This paper explores patient and community insights surrounding self-collection among women living with HIV and HIV[-] women as well as the barriers and facilitators to obtaining and utilizing self-collected specimens in cervical cancer screening programs.Materials and methods: We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews during data collection that took place from May to August 2018. A two-stage sampling strategy was used to select 80 women who participated in six focus group discussions and eight in-depth interviews. We utilized the socio-ecological framework to guide data analysis.Results: All participants indicated that self-sampling was an acceptable method of specimen collection and should be offered as an option for cervical cancer screening in Cameroon. Whereas, most women, regardless of HIV status, preferred the option for self-collection, barriers were identified, such as lack of education about self-collection procedure, being uncomfortable, embarrassed or in pain from the procedure, fear of consequences, perceived competence about ability to self-collect and privacy and confidentiality. We also found that HIV-related stigma was a major concern for HIV[-] women that could prevent them from accessing cervical cancer screening integrated within HIV treatment settings.Conclusions: To promote self-collection for cervical cancer screening, educational interventions with both patients and providers are necessary to increase knowledge of and overall willingness to utilize self-collection. Further research is recommended to examine the role of stigma for HIV[-] women in screening locations associated with HIV treatment.
Highlights
Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening
Women living with HIV (WLWH) advised that those with confidence and knowledge surrounding self-sampling should be given the option to choose between selfand provider collected samples
One study examined such an intervention and found that providers reported a higher importance of selfcollection for human papillomavirus (HPV) testing, an increase in knowledge to educate their patients on the procedure, and overall willingness to recommend self-collection [26]
Summary
Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening. Cervical cancer-related deaths have significantly declined in high income countries (HIC) such as the United States with a 70% decrease from 1955 to 1992 [1] Much of this success can be attributed to extensive development and implementation of cytology screening programs [2]. The national HIV infection rate in Cameroon has decreased from 12% in 1995 to 4.5% in 2014, there has been an increase of AIDSdefining illnesses and cancers in people living with HIV (PLWH) [9, 10] This can be attributed to the longer survival rates of PLWH as well as a marked change in the epidemiology of cancer in the general population, which has reduced the average cancer incidence age by about 8 years [11]. Even with the launching of the National Programme of Vaccination against Human Papillomavirus in Cameroon, the estimated age-standardized incidence rate of cancer of the cervix uteri in Cameroon is 27.7 per 100,000 with 2,356 new cases and 1,546 deaths reported annually [7, 8]
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