The authors declare that they have no competing interests.
AB initiated the topic, coordinated the data collection and analysis and wrote the first draft of the paper. RKW and JNM made input into the design of the study and proposal writing, guided AB in writing the first draft of the paper, and reviewed subsequent versions of the paper. BNM, YK, MO and EK contributed to the interpretation and review of the paper. All authors read and approved the final manuscript.
Cervical 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.
Eighteen (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.
Motivations 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.
These 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.
Lyimo FS, Tanya NB. Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications. BMC Public Health. Volume 12. Accessed on 30 th October, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/22233530
CDC. Cervical Cancer Screening for Women Who Attend STD Clinics or Have a History of STDs. Accessed on 26th May, 2012 from www.cdc.gov/std/treatment/2010/cc-screening.htm-
Franceschi S, Jaffe H. Cervical Cancer Screening of Women Living with HIV Infection: A must in the Era of Antiretroviral Therapy. Clininical Infectious Diseases. 2007; 45(4):510–3. Epub 2007 Jul 5. Retrieved on December 20 th 2012 from http://cid.oxfordjournals.org/content/45/4/510.full
Highleyman L. HPV in Women with HIV-Women and HIV: Human Papillomavirus’, the body. 2007 Retrieved on May 20 th 2012 from http://www.thebody.com/content/art42340.html
Kahesa C, Mwaiselage J, Wabinga HR, Ngoma T, Kalyango J, Karamagi C, Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening. BMC Public Health. 2008 Retrieved on November 10 th, 2012 from http://www.biomedcentral.com/1471-2458/8/262/abstract
Apollinaire H, Antoine J, Didier KE, Badian, T, Patrick AC, Benjamin E EM, Albert M, Raoul M, Mamourou K, François D, Annie JS, The IeDEA West Africa collaboration. Cervical cancer screening by visual inspection in Côte d'Ivoire, operational and clinical aspects according to HIV status. BMC Public Health. 2012 Retrieved on 24th August 2014 from http://www.biomedcentral.com/1471-2458/12/237
Kahesa C, Mwaiselage J, Wabinga HR, Ngoma T, Kalyango J, Karamagi C. Association between invasive cancer of the cervix and HIV-1 infection in Tanzania: the need for dual screening. BMC Public Health. Retrieved on November 10 th, 2012 from http://www.biomedcentral.com/1471-2458/8/262/abstract
WHO, ico. Human Papillomavirus and Related Cancers. Summary Report Update. September 15, 2010. UGANDA. Retrieved on January 4 th 2013 from http://s3.amazonaws.com/zanran_storage/www.who.int/ContentPages/82032421.pdf 10/01/2013
Akinyemiju TF. Socio-Economic and Health Access Determinants of Breast and Cervical Cancer Screening in Low-Income Countries: Analysis of the World Health Survey. PLoS One. 2012;7(11):e48834. Published online 2012 November 14. doi: 10.1371/journal.pone.0048834 Retrieved on 17 th June 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498259/
Singh S, Badaya S. Factors influencing uptake of Cervical Cancer Screening among Women in India: A Hospital based Pilot Study. OMICS Publishing Group. 2012 Retrieved on October 30 th, 2012 from http://www.omicsonline.org/factors-influencinguptake-of-cervical-cancer-screening-among-women-in-india-a-hospital-based-pilot-study-2161-0711.1000157.php?aid=7147
Mutyaba T, Faxelid E, Mirembe F, Weiderpass. Influences on uptake of reproductive health services in Nsangi Community of Uganda and their implications for cervical cancer screening. Reproductive Health. 2007;4:4 doi: 10.1186/1742-4755-4-4.Retrieved on November 2012 from http://www.reproductive-health-journal.com/content/4/1/4
Kennedy CE, Spaulding AB, Brickley DB, Almers L, Mirjahangir J, Packel L, et al. Linking sexual and reproductive health and HIV interventions: a systematic review. J Int AIDS Soc. 2010;13:26. Retrieved on 10th October 2015 from http://www.ncbi.nlm.nih.gov/pubmed/?term=Brickley%20DB%5BAuthor%5D&cauthor=true&cauthor_uid=20642843
Lindegren ML, Kennedy CE, Bain-Brickley D, Azman H, Creanga AA, Butler LM, et al. Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services. Cochrane Database Syst Rev. 2012;9:CD010119. PubMed
Vo BN, Cohen CR, Smith RM, Bukusi EA, Onono MA, Schwartz K, et al. Patient satisfaction with integrated HIV and antenatal care services in rural Kenya. AIDS Care. 2012;24(11):1442-7. doi: 10.1080/09540121.2011.652357. Epub 2012 Feb. Retrieved on 10th October 2015 from http://www.ncbi.nlm.nih.gov/pubmed/22296261]
Liambila W, Askew I, Mwangi J,Ayisi R, Kibaru J, Mullick S. Feasibility and effectiveness of integrating provider-initiated testing and counselling within family planning services in Kenya. AIDS. 2009;23(Suppl 1):S115-21. doi: 10.1097/01.aids.0000363784.96321.43 .Retrieved on 10th October 2015 from http://www.ncbi.nlm.nih.gov/pubmed/20081383
Fletcher FE, Buchberg M, Schover LR, Basen-Engquist K, Kempf MC, Arduino RC, Vidrine DJ. Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic. AIDS Care. 2014;26(10):1229–35. doi: 10.1080/09540121.2014.894617. Epub 2014 Mar 18. Accessed on 3 rd June 2015 from http://www.ncbi.nlm.nih.gov/pubmed/24635664
Kumakech E, Andersson S, Wabinga H, Vanja Berggren V. Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda. BMC Womens Health. 2015;15:23. Published online 2015 Mar 11. doi: 10.1186/s12905-015-0183-4. Accessed on 3 rd June 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359479/
Rositch AF, Gatuguta A, Choi RY, Guthrie BL, Mackelprang RD, Bosire R, Manyara L, Kiarie JN, Smith JS, Farquhar C. knowledge and Acceptability of Pap smears, self –sampling and HPV vaccination among Adult Women in Kenya. PLoS One. 2012;7(7):e40766. Published online 2012 July 10. doi: 10.1371/journal.pone.0040766 PMCID. Accessed on 18/12/2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3393696/
Heather B, Claire T, Claire LT. Cervical Screening within HIV Care: Findings from an HIV-Positive Cohort in Ukraine. public library of science. PLoS One. 2012;7(4):e34708.Retrieved on 16 th June 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335834/
Matovelo D, Magoma M, Rambau P, Massinde A, Masalu N. HIV serostatus and tumour differentiation among patients with cervical cancer at Bugando Medical Centre. BMC Res Notes. 2012 Accessed on December 20 th 2012 from http://www.biomedcentral.com/1756-0500/5/406
Oliver CE, Chidinma VGO, Per Olof O, Karen OP. Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. BMC Public Health. 2013 Published online 2013 January 17. doi: 10.1186/1471-2458-13-46. Retrieved on 16 th June, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567931/
Hansen TB, Hukkelberg S, Haldorsen T, Heriksen T, Skare BG, Nygard M. Factors associated with non-attendance, opportunistic attendance and reminded attendance to cervical screening in an organized screening program: a cross-sectional study of 12,058 Norwegian women. BMC Public Health. 2011. Published online 2011 April 26. doi: 10.1186/1471-2458-11-264. Retrieved on 16 th June 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111379/
Chizoma MN, Bola AO Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: a qualitative study. BMC- Reproductive Health. Reprod Health. 2012;9:11. Published online 2012 August 6. doi: 10.1186/1742-4755-9-11. Retrieved on 16 th June 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539913/
Katzenstein D, McFarland W, Mbizvo M, Latif A, Machekano R, Parsonnet J, et al. Peer education among factory workers in Zimbabwe: providing a sustainable HIVprevention intervention. Geneva: XII International Conference on AIDS. 1998.
- Motivations and barriers to cervical cancer screening among HIV infected women in HIV care: a qualitative study
Joan N. Mutyoba
Rhoda K. Wanyenze
- BioMed Central
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