Abstract
Background Women living with human immunodeficiency virus (HIV) are more likely to develop an increased risk of invasive cervical cancer. Morbidity and mortality due to cervical cancer could be reduced with early detection through cervical screening. Though uptake of cervical screening was investigated in Ethiopia, inconsistent findings were reported. Therefore, this systematic review and meta-analysis was designed to estimate the pooled prevalence of cervical cancer screening uptake among HIV-positive women and its associated factors in Ethiopia. Methods A comprehensive search of PubMed/MEDLINE, Scopus, EMBASE, CINAHL, Google Scholar, Science Direct, and Cochrane Library was conducted. The data were extracted using a standardized data extraction format. Statistical analysis was done using the STATA, version 14, software. The heterogeneity of the studies was assessed using the I2 test. Funnel plots and Egger's test were used to check publication bias. A random effects model was computed to estimate the pooled prevalence of cervical cancer screening uptake. Moreover, pooled odds ratios with 95% confidence intervals were used to determine the association of identified determinant factors with cervical cancer screening uptake. Results A total of 10358 studies were retrieved, and 7 studies were included in the meta-analysis. The pooled prevalence of cervical cancer screening uptake among HIV-positive women in Ethiopia was 18.17% (95% CI : 11.23, 25.10) with exhibited heterogeneity (I2 = 96.6%; p < 0.001). Educational status of women (AOR = 3.50; 95% CI : 1.85, 6.07), knowledge of women on cervical cancer (AOR = 3.26; 95% CI : 2.50, 4.43), and perceived susceptibility (AOR = 3.26; 95% CI : 2.26, 4.26) were significantly associated with cervical cancer screening uptake among HIV-positive women. Conclusion The uptake of cervical cancer screening among HIV-positive women in Ethiopia was low. The findings of this study suggest the need to improve the existing national strategies of cervical cancer screening so as to strengthen reproductive health education and promotion, in addition to providing screening services. Furthermore, cervical screening service should be integrated to the routine care and treatment, so that HIV-positive women can get counseling services in every clinical contact.
Highlights
Women living with human immunodeficiency virus (HIV) are more likely to develop an increased risk of invasive cervical cancer
Recent report from the Information Centre on human papillomavirus (HPV) and Cancer revealed that approximately 29.43 million women aged above 15 years were at risk of CC in Ethiopia [7]
Several studies indicated that women living with human immunodeficiency virus (HIV) have a greater incidence of HPV infection than do the general population [8, 9]. ey are more likely to develop an increased risk of premalignant lesion of the cervix [10, 11]. e literature revealed that immunosuppression with low CD4 counts predisposes women living with HIV infection to high risk for cervical cancer [9, 12,13,14,15]
Summary
In most of the developing countries, both morbidity and mortality due to cervical cancer (CC) are increasing [1,2,3]. Ethiopia adopted cervical cancer prevention and control guideline from the WHO and recommend women to get screening for cervical cancer at least every five years following normal results irrespective of HIV status interval to achieve 80% coverage [28, 29]. Both arranged and opportunistic cervical cancer screening are available, and a number of women are expected to be benefited from it [23, 30]. Several fragmented studies have been conducted to assess uptake of cervical cancer screening and associated factors among HIV-positive women in Ethiopia. The finding of this study may help the health workers to integrate cervical cancer screening services and counseling within their activities, so that the incidence and mortality associated with cervical cancer could be reduced through early diagnosis and treatment
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