Abstract
BackgroundCervical cancer is the second commonest cancer in women worldwide and the commonest cancer among women in Uganda. Annual cervical screening is recommended for women living with HIV for early detection of abnormal cervical changes, however uptake remains grossly limited. This study assessed factors associated with cervical screening uptake among HIV infected women at Mildmay Uganda where cervical screening using Visual inspection with acetic acid and iodine (VIA and VILI) was integrated into HIV care since July 2009.MethodsEighteen (18) in-depth interviews with HIV infected women and 6 key informant interviews with health care providers were conducted in April 2013 to assess client, health care provider and facility-related factors that affect cervical screening uptake. In-depth interview respondents included six HIV infected women in each of the following categories; women who had never screened, those who had screened once and missed follow-up annual screening, and those who had fully adhered to the annual screening schedule. Data was analyzed using content analysis method.ResultsMotivations for cervical cancer screening included the need for comprehensive assessment, diagnosis, and management of all ailments to ensure good health, fear of consequences of cervical cancer, suspicion of being at risk and the desire to maintain a good relationship with health care workers. The following factors negatively impacted on uptake of cervical screening: Myths and misconceptions such as the belief that a woman’s ovaries and uterus could be removed during screening, fear of pain associated with cervical screening, fear of undressing and the need for women to preserve their privacy, low perceived cervical cancer risk, shortage of health workers to routinely provide cervical cancer education and screening, and competing priorities for both provider and patient time. Major barriers to repeat screening included limited knowledge and appreciation of the need for repeat screening, and lack of reminders.ConclusionsThese findings highlight the need for client-centered counseling and support to overcome fears and misconceptions, and to innovatively address the human resource barriers to uptake of cervical cancer screening among HIV infected women.
Highlights
Cervical cancer is the second commonest cancer in women worldwide and the commonest cancer among women in Uganda
The In-depth interview (IDI) respondents included women who had never screened for cervical cancer (6 women), those who had screened only once and missed subsequent screening (6 women), and those who had fully adhered to their annual cervical screening schedule (6 women)
The key informants included two nurses from the cervical cancer screening unit, one nurse from the nurse-led Human Immune Deficiency Virus (HIV) clinic, one clinician from the adult HIV clinic and one from the paediatric/family clinic, and one “expert” client (HIV infected client who has been in care for a long time and has exemplary practices in relation to HIV service health seeking behaviors)
Summary
Annual cervical screening is recommended for women living with HIV for early detection of abnormal cervical changes, uptake remains grossly limited. The burden of cervical cancer is highest in sub Saharan Africa (almost twice the global burden) and even higher among HIV infected women [1,2,3,4,5,6]. Cervical cancer is more aggressive in the HIV infected women, the recommendation to integrate cervical screening in routine HIV services [6, 7]. Cervical cancer related deaths are highest in Uganda at 15.6 % compared to 13.8 % for East Africa and 8.2 % worldwide [8].
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