Cervical Cancer Prevention and High-Risk HPV Self-Sampling Awareness and Acceptability among Women Living with HIV: A Qualitative Investigation from the Patients' and Providers' Perspectives.

Daisy Le,Laura Isabel Gonzalez,Min Jeong Jeon,Annie Coriolan Ciceron,Jeanne A Jordan,Beverly Long,Jose Bordon

doi:10.3390/curroncol29020047

Daisy Le, Laura Isabel Gonzalez + Show 5 more

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https://doi.org/10.3390/curroncol29020047

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Abstract

Routine cervical cancer screening is important for women living with HIV (WLH) due to the greater incidence and persistence of high-risk HPV (HR-HPV) infection. HR-HPV self-sampling has been proposed to overcome barriers to in-office cervical cancer screening in underserved populations. However, little is known about baseline knowledge of HR-HPV and the acceptability of HR-HPV self-sampling among WLH. This paper describes WLH’s experiences and needs regarding cervical cancer screening, specifically HR-HPV self-sampling, and seeks to reconcile their experiences with the views of their providers. In total, 10 providers and 39 WLH participated in semi-structured interviews and group discussions, respectively. Knowledge of cervical cancer and HR-HPV was generally limited among WLH; when present, it was often due to personal experience of or proximity to someone affected by cervical cancer. Most WLH were not familiar with HR-HPV self-sampling but, despite some of the providers’ skepticism, expressed their willingness to participate in a mail-based HR-HPV self-sampling intervention and highlighted convenience, ease of use, and affordability as facilitators to the uptake of HR-HPV self-sampling. The experiences identified can be used to guide patient-centered communication aimed at improving cervical cancer knowledge and to inform interventions, such as HR-HPV self-sampling, designed to increase cervical cancer screening among under-screened WLH.

Highlights

Women living with HIV (WLH) bear a disproportionate risk of high-grade cervical intraepithelial neoplasia (CIN2+) and invasive cervical cancer due to greater incidence and longer persistence of high-risk human papillomavirus (HR-HPV) infection in this population [1,2,3]
Major themes relevant to this paper were organized into five domains: (1) attitudes towards cervical cancer, (2) awareness and knowledge of cervical cancer and HR-HPV, (3) facilitators and barriers to screening, (4) awareness and knowledge of HR-HPV selfsampling, and (5) feasibility and acceptability of HR-HPV self-sampling
HR-HPV self-sampling is appealing to our study population and could reach these under-screened women by bypassing the typical barriers to officebased screening

Summary

Introduction

Women living with HIV (WLH) bear a disproportionate risk of high-grade cervical intraepithelial neoplasia (CIN2+) and invasive cervical cancer due to greater incidence and longer persistence of high-risk human papillomavirus (HR-HPV) infection in this population [1,2,3]. In women age 30 or greater, follow-up cytology and HR-HPV co-testing is performed every 3 years if the initial co-testing result is negative [13]. While there is a paucity of research regarding knowledge of cervical cancer and HR-HPV screening among WLH, limited evidence indicates suboptimal knowledge of HR-HPV transmission and cervical cancer prevention [14,15,16]. Reliable risk calculation is especially important since WLH face additional barriers to screening, including social and economic factors, stigma specific to co-infection, perceived pain, embarrassment, bodily modesty, fear of diagnosis of serious illness, and limited access to female providers [14,15,16]

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