Cervical Neoplasia in Women Living With HIV at Cervical Cancer Screening Clinics in Mutare, Eastern Zimbabwe

Auxilia Chideme Munodawafa,Faculty Of Health Sciences, Africa University, Mutare, Zimbabwe

doi:10.15436/2380-5595.16.1158

Auxilia Chideme Munodawafa, Faculty Of Health Sciences, Africa University, Mutare, Zimbabwe

Open Access

https://doi.org/10.15436/2380-5595.16.1158

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Abstract

Title: Cervical neoplasia in women living with HIV at cervical cancer screening clinics in Mutare, Zimbabwe, 2015. Introduction: Cervical cancer in H IV infected women occurs at a younger age and progresses faster compared to those without the HIV infection. In resource limited setting with HIV prevalence like Zimbabwe targeted screening of women living with HIV is an option. The aim of the study was to determine the prevalence of cervical neoplasia and the risk factors amongst HIV infected women attending cervical screening clinics.Methods: A cross sectional study was conducted at visual inspection with acetic acid and cervicography (VIAC) clinics, in Mutare city in Eastern Zimbabwe from May to July 2015. Two hundred and forty four women living with HIV who were screened for cervical cancer were enrolled in the study. Data were collected by an interviewer administered structured and pretested questionnaire. Data was entered and analysed using Epi info version 7.0.Results: Out of the 242 participants, 77(31.8%) had cervical abnormality. For the abnormalities 28 underwent cryotherapy, 29 for LEEP and 20 with invasive cancer were referred and attended to in gynaecological clinic. History of genital warts [AOR 5.80(2.00; 16.90)], having more than one lifetime sexual partner [AOR 3.20 (1.16; 8.86)], first pregnancy after the age of 18 [AOR 0.32(0.10; 0.97)], CD4 count ≥ 250 copies/mm3 at antiretroviral commencement [AOR 0.27(0.09; 0.85)] and a latest CD4 count ≥ 500 cell/mm3 [AOR 0.25(0.09; 0, 68)] were independent factors associated with cervical neoplasia.Conclusion: The prevalence of cervical neoplasia among women living with HIV is high and cervical screening should be part and parcel of management of these women. The need of early initiation of highly active antiretrovirals cannot be over-emphasised.

Highlights

Cervical cancer is the second most common cancer amongst women[1]
Women who had sexual debut before 18 were associated with a positive visual inspection with acetic acid and cervicography (VIAC) finding [Odds Ratios (ORs) 2.01, 95% Confidence Intervals (CI) (1.12; 3.63), p = 0.02] but this was not a predictor of cervical neoplasia after multiple
Occupation or income were reported to affect risk of VIAC positivity by Kahesa et al[28], but we found no association and our findings were supported by Atashili et al,[29] in Cameroon

Summary

Introduction

Cervical cancer is the second most common cancer amongst women[1]. Screening using the Pap smear has reduced the burden of cervical cancer in the developed world to rates as low as 8.5 per 100 000 women in the USA. According to World Health Organisation[3], about 270 000 women die of cervical cancer every year in the low and middle income countries, this accounts for more than 80% of the Attribution 4.0 International License. Cervical cancer is the commonest cause of cancer mortality in Africa (10.4% of all cancer deaths) and contributes 20% of all cancer deaths in African women[4]. The most common cancers amongst black Zimbabwean women in 2008, according to cancer registry[5] were cervical cancer 33.8%, breast cancer at 11.6%, and Kaposi Sarcoma 10.7%. Vaccination for HPV in Zimbabwe is at piloting stage with 2 districts involved and results of the pilot study only available in 2017, when decision will be made on rolling out of program

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