Background
Methods
Study design
Study sites
Participant category | Study site | Total | ||||
---|---|---|---|---|---|---|
Kampala | Mbarara | Ibanda | FGDs | IDIs | Participants | |
Women | 2 FGs with a total of 13 participants | 2 FGDs with a total of 12 participants | 2 FGDs with a total of 15 participants | 6 | 0 | 40 |
Village health teams (VHTs) | 2 FGDs with a total of 11 participants | 2 FGDs with a total of 12 participants | 2 FGDs with a total of 13 participants | 6 | 0 | 36 |
Men | 4 IDIs | 4 IDIs | 4 IDIs | 12 | 12 | |
Total FGDs | 4 | 4 | 4 | 12 | ||
Total IDIs | 4 | 4 | 4 | 12 | ||
Total participants | 28 | 28 | 32 | 88 |
Selection criteria for study sites
Study respondents
Sample size
Study field team and procedures
Sampling method for participants
Eligibility criteria for study respondents
Participants’ recruitment procedure
Data collection method
Focus group/interview guide
Data analysis
Rigor of the research
Ethical considerations
Reporting guidelines
Results
Perceived benefits
Time saving
“It will save us time in terms of making a return journey for the other service”. –Women’s FGD, Kampala.“It would save us time because we the women of nowadays are working for our families. Our husbands are no longer responsible. So if we can get a service like this which addresses two issues, then we shall not lose out in terms of time to go and work so that we earn money for a living”. – Women’s FGD, Kampala.
Transport cost saving
“Screening for both [HIV and CC] on the same day is very good and women will like it because people come from very far so it will help on paying for transport fares once instead of going and coming back which is double transport”. – Male interviewee, Ibanda.
Productive use of women’s time at the hospital
“Screening for both HIV and CC on the same day is good and women will like it because we always forgo one day to come to hospital so if we are screened for both it is good because you would have utilized your day well”. – VHT FGD, Ibanda.
Queuing once
“What we don’t want is delaying us like yesterday where I spent too much time in the hospital since the women were so many there. So it is better to do everything at the same place or near each other. This makes the process faster”. – Women’s FGD, Kampala.
Convenience
“The integration will be good because it does not require one to move from place to place. Everything is done in one place”. –Women’s FGD, Kampala.
Discovery of unsuspected diseases
“The integration is not bad because we have some illnesses that we do not know that we have. Integration will enable healthcare providers to catch and treat them promptly” – VHT FGD, Mbarara.“Yes, I also think integration will enable healthcare providers to tell whether a woman is also suffering from other diseases of the private parts (reproductive system) for example Candida”. – VHT FGD, Mbarara.
Brief or short stress or anxiety about screening
“If you know your CC status, you can at the same time know your HIV status and the advantage is that it prevents prolonged anxiety”. – Women’s FGD, Mbarara.“When you test for both CC and HIV at once, the stress comes once, and when you are well counseled it’s okay”. – Women’s FGD, Kampala.
Promotes confidentiality
“It also helps to keep confidentiality because whatever comes out of the screening will be between you and the health workers who performed both screening”. – Women’s FGD, Kampala.
Improves HIV and CC screening coverage
“It will be good to integrate because even though you have come for another illness, they will take advantage of that and also screen you”. – Women’s FGD, Kampala.“More women will benefit because if the woman leaves home after telling the husband that she is going for an HIV test and comes to understand that there is also screening for cancer, an issue that concerns her then she will also be screened for cervical cancer without necessitating her to ask permission from the husband which might take the man more time to be decided for her to come for the CC screening”. – Male Interviewee, Ibanda.
Good for women from remote villages
“We the village women will prefer this integration because it saves us on time and transport. Compared to the town women because they are near the services and can access it any time they want or when they are free”. – Women’s FGD, Ibanda.“The women in the village will like it more because these women also have their work. They wake up very early in the morning and go to the garden so if it is a one day issue then they will welcome it because they will have to lose only one day and then the other days they resume their work”. – Women’s FGD, Kampala.
Good for busy working women
“For my case if I go to the hospital the integration will help me because I have work to attend to and yet I have limited time. Women of now days have work to do. It is not like those days where women were just sited at home”. – VHT FGD, Kampala.
Good for HIV-positive women
“Us HIV-positive women who are here right now we are the first to like the idea of integration. Even the health workers told us that it is good to go for the cervical cancer screening and you know your status such that if you don’t have then you are free and if you have it, then they will give you free treatment”. – Women’s FGD, Kampala.
Perceived challenges
Prolonged waiting time at the hospital
“What we don’t want is delaying us like yesterday where I spent too much time in the hospital since the women were so many there”. – Women’s FGD, Kampala.“If the integration will take so long time that even the means of transport that we are to use has left us then we have to sleep over yet we have not planned for such conditions, this will not be good because in most cases you do not have anyone you know in town and at the same time you might have left your children with no one to take care of them”. – Women’s FGD, Mbarara.
Tiring to the HCPs and the women
“It wouldn’t be bad but its tiring on the side of a health worker. The health workers will get tired and will make the clients also tired”. – Women’s FGD, Mbarara.“Boredom, if you wait for a long time in the queue”. – Women’s FGD, Kampala.
Stress and social consequences of double positive results
“One is stressed, after knowing I am HIV positive and they again find I am also CC positive, I get stress, after reaching home I am stressed, they would know my problem even if I don’t tell them”. – Women’s FGD, Ibanda.“It’s not safe for the women, because after the husband knows that I am positive for both HIV and CC its very bad, he will say I am tired of you. And the husband will start barking at her, some husband may kill you or leave the family and go [divorce]. To avoid that some women fear to go and test, because of fear of how they will share the positive results with the husband and the rest of the family. So the women say even if it’s to die, let us die. We normally see these cases of negative reactions of husbands to positive health status of their women in our communities”. – Women’s FGD, Mbarara.
Preferences
Multi-skilled or transdisciplinary team to perform screening for both HIV and CC within the integrated program
“The same HCP team will help in saving time and also the health workers get to know you better”. – Women’s FGD, Mbarara.
Interspecialty or interdisciplinary team to perform the different screenings for HIV and CC within the integrated program
“It is better for different health workers to screen you for the different services because one health workers might know you so much so you might not be comfortable with that one knowing you so much so you would prefer another one to handle the other screening”. – Women’s FGD, Kampala.“Because everyone has his/her specialty which he or she studied so the one screening for cancer should do that and the one screening for HIV should also do his part”. – Women’s FGD, Ibanda.
Same place or nearby locations to house the integrated screening program
“…. it is better to do everything at the same place or near each other. This makes the process faster”. – Male Interviewee, Mbarara.“the problem we get is moving from here to there and after make a line for a service, so if the rooms are close to each other, then one will come from one room and after go to the other room to see the next doctor”. – Women’s FGD, Kampala.
Village-level health centers for the integrated screening program
“In the health centers that are in the villages. This would help us on issues concerning distance and transport”. – Women’s FGD, Mbarara.“At some centers in the villages where one can be in position to even ride a bicycle and access the service”. – Male Interviewee, Ibanda.“We would welcome the idea of integration more if they also bring us the services down in the villages and not leaving it in only to the town hospitals”. – Women’s FGD, Ibanda.
Large hospitals for the integrated screening program
“It needs big hospitals so that there is enough space to examine many people.” – Women’s FGD, Ibanda.“These services should be put in the big hospitals because the big hospitals have many health workers who can treat many illnesses.” – Women’s FGD, Kampala.“Screening of theses illnesses should be put in the big hospitals because the clinics cannot manage.” – Women’s FGD, Mbarara.
Public or government hospitals for the integrated screening program
“These screenings should be in the government hospitals because ….. in the government hospitals they will work on you as a government person”. – Women’s FGD, Kampala.
Integrated screening free of charge
“With this disease (cervical cancer) someone will not be in pain so it will not be easy for someone to get money and pay if they have no pain and she is not bed ridden so if you put a fee on it, then the project will not move well”. – Women’s FGD, Kampala.“Not everyone will use this service if a fee is put to it because if someone does not get sick to the level of being bed ridden, then the person will not mind the screening test. It will be very difficult for people if they put a fee for the service”. – VHT FGD, Kampala.“For some women it might be difficult because their husbands cannot give them the 2000 Uganda shillings to go for a test when they are not in pain”. – Male Interviewee, Kampala.“If cancer screening is for money then it means that the drugs will also be for money and yet someone has already spent on transport so people will say that they better die because they do not have all that money”. – Women’s FGD, Ibanda.
Male partner’s involvement
“For us as ladies we shall like the integration but it does not concern the men. So I don’t think that they will like it because it does not concern them”. – Women’s FGD, Kampala.“It is very hard for a woman to convince her husband to go with her for HIV and cervical cancer screening so the man will not be around”. – Male Interviewee, Ibanda.“Some husband will refuse because they mistrust their wives, they would fear that she is lying to go and cheat with their boyfriends”. – Male Interviewee, Kampala.“If the men are well counseled and they are told that their wives have to be screened and if found to be having CC, then it can be treatable. The men will have no problem with it actually he will even welcome the idea……since cancer is a disease that scares everyone because it has no rescue”. – VHT FGD, Kampala.
Educating the community about the integrated screening program
“We are not supposed to be stressed by integration if there were education and counseling. Counseling helps much. There is no anything other thing that can happen if there is counseling”. – Women’s FGD, Mbarara.
Dedicating a full day to the integrated screening program
“For us the day we set for hospital is taken as a day for hospital and it means I will not go to work and I will also leave all the house hold chores. If I leave home I inform them that I have gone to hospital so they do everything and even though I reach late, I find everything done and I just rest. So we shall like the integration because you have set aside that hospital day so you have to be patient and everything is done on that day that you have set for hospital”. – Women’s FGD, Kampala.“We shall like this new program because when you leave home for hospital it means you have given the hospital the whole day so there is no point of feeling that you are delayed”. – Women’s FGD, Mbarara.
Being patient
“You can be patient because you are already there and you have been brought by the problem so you have to solve it so that you can save on your transport coming there for the same service on another day”. – Women’s FGD, Mbarara.“We are used to that kind of schedule because when you leave home to go to hospital, the time they release you after they have worked on you that is the time you consider as your departure time so you have to be patient and they work on you”. – Women’s FGD, Kampala.
Coming prepared with packed lunch
“If we get to know that it takes the whole day then we shall come when we are prepared in terms of lunch”. – Women’s FGD, Kampala.