Barriers to accessing cervical cancer screening among HIV positive women in Kgatleng district, Botswana: A qualitative study

Tjedza G Matenge,Bob Mash,Geofrey Musinguzi

doi:10.1371/journal.pone.0205425

Abstract

BackgroundLow and middle-income countries have a greater share of the cervical cancer burden, but lower screening coverage, compared to high-income countries. Moreover, screening uptake and disease outcomes are generally worse in rural areas as well as in the HIV positive population. Efforts directed at increasing the screening rates are important in order to decrease cancer-related morbidity and mortality. This study aimed to explore the barriers to women with HIV accessing cervical cancer screening in Kgatleng district, Botswana.MethodsA phenomenological qualitative study utilising semi-structured interviews with fourteen HIV positive women, selected by purposive sampling. The interviews were transcribed verbatim and the 5-steps of the framework method, assisted by Atlas-ti software, was used for qualitative data analysis.ResultsContextual factors included distance, public transport issues and work commitments. Health system factors highlighted unavailability of results, inconsistent appointment systems, long queues and equipment shortages and poor patient-centred communication skills, particularly skills in explanation and planning. Patient factors identified were lack of knowledge of cervical cancer, benefits of screening, effectiveness of treatment, as well as personal fears and misconceptions.ConclusionCervical cancer screening was poorly accessed due to a weak primary care system, insufficient health promotion and information as well as poor communication skills. These issues could be partly addressed by considering alternative technology and one-stop models of testing and treating.

Highlights

Cervical cancer is a global public health issue, affecting women, and their families, communities and social institutions.[1]
Screening uptake and disease outcomes are generally worse in rural areas compared with urban areas because the population is substantially poorer and access to health services is more difficult.[3]
The aim of the study was to explore the barriers for women with HIV from accessing cervical cancer screening in Kgatleng district, Botswana

Summary

Introduction

Cervical cancer is a global public health issue, affecting women, and their families, communities and social institutions.[1] It is the second leading cause of cancer-related mortality among women globally, it is one of the most preventable cancers due to its slow progression, identifiable cytological precursors and effective treatment.[1,2] Even though the disease is preventable, more than half a million women worldwide develop invasive cervical cancer each year.[3] Low and middle income countries bear a disproportionate share (83%) of the global cervical cancer burden, but only manage an average screening coverage of 19%, compared to 63% in high income countries.[2] Screening uptake and disease outcomes are generally worse in rural areas compared with urban areas because the population is substantially poorer and access to health services is more difficult.[3] The burden of disease from cervical cancer falls more on older women who are post-childbearing and who are important to both family stability and the broader economy.[4]. This study aimed to explore the barriers to women with HIV accessing cervical cancer screening in Kgatleng district, Botswana

Objectives

Methods

Conclusion