Understanding barriers to access and utilization of cervical cancer screening services among women living with HIV in Kenya and Uganda: a cross-sectional study

Abstract

INTRODUCTION: Invasive cervical cancer (ICC) is preventable and curable. However, it is the fourth leading cause of cancer mortality among women globally, especially in low- and middle-income countries. Whereas studies reveal the existence of ICC pre-cancerous lesion screening services in Kenya and Uganda, uptake of these services remains low, highlighting the existence of unidentified barriers. This study explored factors that impede access and utilization of pre-cancerous cervical screening services among women living with HIV in low resource settings in Uganda and Kenya. METHODS: a cross-sectional study design was used in six selected health facilities in Uganda and Kenya. A systematic cluster randomized sampling was used to select health facilities for women living with HIV who were invited to participate in the interviews. Data collection, coding, categorization, and statistical analysis of quantitative data were employed to rank and correlate among the most critical factors of the Health Belief Model framework. RESULTS: the results showed a negative correlation between the perceived barriers and the risk of accessing the services (-0.95, p-value 0.003) and the perceived severity (-0.95, p-value 0.004), both mean that the barriers for the women are so high that they prefer to delay the visit to the hospital. More, there was a positive correlation between perceived risk for ICC and perceived severity (0.90, p-value 0.01), meaning that a high perception of risk of ICC will increase its severity. Health system barriers to access such as lack of supplies, information, and limited staffing were also revealed. CONCLUSION: the study uncovered the health system barriers affecting ICC screening services at health facilities in Kenya and Uganda and their effects on the perceived illness. Also, it highlights the strengths and challenges while providing recommendations to promote health that includes the most vulnerable women with HIV living in socially deprived areas.