Screening, prevalence, and risk factors for cervical lesions among HIV positive and HIV negative women in Swaziland

Pauline E Jolly,Amarachi Ejiawoko,Shacoria Winston,Tomi F Akinyemiju,Simangele Mthethwa-Hleta,Peter O Preko,Hannah J Turner,Lena Preko,Jessica Pettis,Luz A Padilla,Raina Brooks

doi:10.1186/s12889-017-4120-3

Abstract

BackgroundCervical Cancer (CC) is the number one cancer among women in sub-Saharan Africa. Although CC is preventable, most women in developing countries do not have access to screening.MethodsThis cross-sectional study was conducted to determine the prevalence and risk factors for cervical lesions using visual inspection with acetic acid (VIA) among 112 HIV positive and 161 negative women aged 18–69 years.ResultsThe presence of cervical lesions was greater among HIV positive (22.9%) than HIV negative women (5.7%; p < 0.0001). In logistic models, the risk of cervical lesions among HIV positive women was 5.24 times higher when adjusted by age (OR 5.24, CI 2.31–11.88), and 4.06 times higher in a full model (OR 4.06, CI 1.61–10.25), than among HIV negative women. In the age-adjusted model women who had ≥2 lifetime sexual partners were 3 times more likely (OR 3.00, CI 1.02–8.85) to have cervical lesions compared to women with one lifetime partner and the odds of cervical lesions among women with a history of STIs were 2.16 greater (OR 2.16, CI 1.04–4.50) than among women with no previous STI. In the fully adjusted model women who had a previous cervical exam were 2.5 times more likely (OR 2.53, CI 1.06–6.05) to have cervical lesions than women who had not.ConclusionsThe high prevalence of HIV infection and the strong association between HIV and cervical lesions highlight the need for substantial scale-up of cervical screening to decrease the rate of CC in Swaziland.

Highlights

Cervical Cancer (CC) is the number one cancer among women in sub-Saharan Africa
Compared with HIV negative women, HIV positive women are more likely to be infected with Human Papillomavirus (HPV) and to have persistent HPV leading to pre-cancer, larger and more difficult to treat precancerous lesions, higher recurrence rates of pre-cancer following treatment, and precancerous lesions that progress more rapidly to invasive cancer [5,6,7]
When bivariate analysis was conducted between sociodemographic variables and HIV status, significant associations were found between HIV status and age, income, and level of education (Table 1)

Summary

Introduction

Cervical Cancer (CC) is the number one cancer among women in sub-Saharan Africa. CC is preventable, most women in developing countries do not have access to screening. Cervical cancer (CC) is the fourth most common cancer in women worldwide and the number one cancer among women in sub-Saharan Africa. CC is preventable, most women in resource-poor countries do not have access to a screening program. Compared with HIV negative women, HIV positive women are more likely to be infected with HPV and to have persistent HPV leading to pre-cancer, larger and more difficult to treat precancerous lesions, higher recurrence rates of pre-cancer following treatment, and precancerous lesions that progress more rapidly to invasive cancer [5,6,7]. Invasive CC and its precursor, cervical intraepithelial neoplasia (CIN), are associated with

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Results