| dc.description.abstract | Background: Cervical cancer disproportionately affects women living with HIV, given that they
experience relatively more severe disease sequelae, and poor prognosis. That is in addition to
the fact that they are more likely to experience cervical cancer treatment failure, have a higher
risk of adverse events and recurrence following treatment. That makes them have a 10-fold
mortality risk, making them a significant target group for cervical cancer prevention. Being
mainly above the eligible age for vaccination, they can mostly benefit from cervical cancer
screening (CCS), that they ought to do annually. Few of them are however doing so, globally, in
Africa, in Uganda, and in Mbarara district, particularly Mbarara municipality. The purpose of
this study was to investigate the level of cervical cancer screening uptake and its determinants
among women living with HIV in Mbarara Municipality.
Method: An analytical cross-sectional survey was used; stratified and simple random sampling
was used to sample the health facilities, while simple random sampling was used to sample the
women who were engaged in structured interviews, with their clinical data collected using
medical record abstraction. The data collected has been analyzed using descriptive and
inferential statistics (robust Poisson), in SPSS version 25.
Results: Less than a quarter of the women living with HIV 22% (33/153) had sought and
received cervical cancer screening annually between the years 2017 and 2019. At an individual
level, CCS was associated with non-affordability of annual CCS (aPR = 1.153, CI = 1.042 -
1.275), attendance of community outreaches for health (aPR = 1.124, CI = 1.012- 1.247),
perceptions of non-embarrassment of screening (aPR = 1.186, CI = 1.018 - 1.382), knowledge of
the cause of cervical cancer (aPR = 0.810, CI = 0.702 - 0.934), knowledge that a virus causes
cervical cancer (aPR = 0.744, CI = 0.660 - 0.839), perception that screening can lead to
enlargement of private parts (cPR = 0.886, CI = 0.795 - 0.988), being currently sexually active
(aPR = 0.834, CI = 0.746 - 0.931), perceived benefit of screening (aPR = 1.253, CI = 1.050 -
1.495), being para 1 (aPR = 0.664, CI = 0.484 - 0.911), being married (aPR = 0.899, CI =
0.821 - 0.984), and the born again (aPR = 0.836, CI = 0.743 - 0.941, P = 0.003), formal
education (aPR = 0.911, CI = 0.850 - 0.977, P = 0.009) and primary education (aPR = 1.458,
CI = 1.203 - 1.767). At a clinical level, CCS was associated with four-year duration on ART
(aPR = 1.111, CI = 1.040 - 1.180), duration since diagnosis (aPR = 0.705, CI = 0.580 - 0.857,
functional status (aPR = 0.903, CI = 0.834 - 0.979), viral load less than 1000 (aPR = 0.895, CI
= 0.820 - 0.977). At an institutional level screening is associated with education about the need
for CCS (cPR = 0.893, CI = 0.832 - 0.958), education about CCS along with partners (aPR =
1.124, CI = 1.036 - 1.218), and sufficient staffing at facility (aPR = 1.199, CI = 1.096 - 1.313).
Conclusion: Cervical cancer screening uptake among women living with HIV in Mbarara
municipality is low; whereas lifetime screening is fairly high among them, adherence to the
screening protocol is low. Only 2 in 10 of them screen annually. Such a health seeking behavior
is determined, by mainly their individual characteristics, and to an extent by clinical and health
care service characteristics.
Recommendations: There is a need to sensitize the HIV positive women that cervical cancer
screening is free at public health facilities, couple health education is key, need to address all the
misconceptions surrounding the screening among others | en_US |
