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Among WLWHIV, cervical cancer is one of the main reasons of morbidity and mortality, which is why it has become paramount to explore the level of awareness, knowledge, uptake, and willingness to screen for cervical cancer. Participation in this study was relatively high, with a response rate of 71% at HIV CTC in DRRH Dodoma. Similar studies in HIV clinics across Africa have received high response rates. The response rate of the studies in Nigeria was 91%; in Ethiopia, 97%; and 100% in Durban, South Africa.
This indicates that the WLWHIV in sub-Saharan Africa is willing to participate in studies related to the improvement of their health. This participatory attitude observed among WLWHIV could suggest high reception to health education and research involving public health issues.
HIV clinic administrators could take advantage of this and introduce additional programs to positively impact the health outcomes of WLWHIV. The level of awareness of cervical cancer was found to be high (73%) in this study, with the media representing the highest (76%) source of information.
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The media was also found to be the highest source of information for cervical cancer in a similar study carried out in Dar es Salaam. However, the uptake of cervical cancer is low (16%) among WLWHIV, this may not be surprising based on our findings as the general knowledge of cervical cancer among women at HIV CTC is poor. It is possible that the information publicized by the media about cervical cancer may be inadequate or misleading hence resulting in poor attitude towards uptake of cervical cancer screening.
Most of the women (89%) in this study did not believe that WLWHIV have higher risk of developing cervical cancer and many (93%) did not know the primary cause of cervical cancer neither did most of the women (72%) believe that having multiple partners increases the risk of cervical cancer nor do they know that women who have a family history of cervical cancer are at risk (99%).
By this, we have supported the report that knowledge of cervical cancer may be different from awareness. Findings from other studies reported that most WLWHIV in both developed and underdeveloped countries do not perceive to be at risk of cervical cancer. Similarly, in this current study, we showed that 81% do not perceive to be at risk of cervical cancer. This points to the lack of proper education on the risk of cervical cancer among HIV infected women.
In this current study, we explored the different socio-demographic factors that may be associated with awareness and uptake of cervical cancer. We found a significant association between age and awareness of cervical cancer. Women of age group 30-39 years were found to be 2 times more likely to have heard of cervical cancer when compared to women of age group 18-29 years. Uptake of cervical cancer screening was found to increase as age increases in this current study. Similar findings were reported in the studies conducted in Kenya, Ethiopia and Nigeria. As 30-39 years old is the reproductive age for most women, the high awareness and uptake of cervical cancer screening might be due to more exposures to reproductive care than women of other age groups.
Findings from this current study suggest that women residing in urban areas were more likely to be aware and uptake cervical cancer screening as compared to rural dwellers. The disparity in terms of awareness of cervical cancer between rural and urban women at the HIV CTC validates the media as the primary source of information on cervical cancer instead of the HIV CTC. If HIV CTC, which is the meeting point for care delivery for both rural and urban WLWHIV is the source of awareness on cervical cancer, the level of awareness for both rural and urban WLWHIV would be the same. This is not surprising as it addresses the issue of access to information on cervical cancer which might have placed the urban women at an advantage. The gap in access to information can be bridged by providing necessary and adequate information to women at the HIV CTC.
Beyond access and availability of screening, the gap which may potentially exist in the attitude to screen and knowledge by urban versus rural dwellers is another issue that requires more attention. In this study, the uptake of cervical cancer screening by HIV positive women was 16% between 2014 and August 2017 which is close to the screening rates reported by studies conducted in Dar es Salaam, 9%, Kilimanjaro region Tanzania 6% Nigeria 9% , Addis Ababa 12% and 10% in northwest Ethiopia. These figures emphasize the need for cervical cancer screening among HIV women in many HIV clinics in Sub Sahara Africa. South Africa 32%, Western Kenya 84% have reported a relatively elevated screening rate which could be due to consistent education, access and availability of free screening services which is missing at HIV CTC in Dodoma.
The willingness to screen for cervical cancer among women who reported to have never screened for cervical cancer is 90% in this current study. Lower prevalence of women indicating willingness to screen were reported in studies conducted in Nigeria 80% Ethiopia 62.7% Ghana 82% and Kenya 44%. Despite the low uptake of cervical cancer screening observed in our findings, the high prevalence of willingness to screen among women at HIV CTC speaks volume on the success that would be achieved if cervical cancer screening is integrated to HIV care delivery services. Previous studies reported that older age was associated with willingness to screen. In contrast to findings from previous studies, we found that young age at HIV CTC is significantly associated with cervical cancer screening.
Although the risk of cervical cancer is high among HIV women, it is even higher among older women as compared to younger women, it thereby makes it important to target older women who may be unwilling to screen for cervical cancer when strategizing intervention and education for uptake of cervical cancer at HIV CTC. Other studies we reviewed with a similar objective as this current study did not determine if the geographical location could predict the willingness to screen among women living with HIV. We, however, included the geographical location in our model to determine the impact of residential location on the willingness to screen. We found that participants residing in urban areas were more willing to be screened as compared to their counterparts in rural areas.
However, this study did not investigate the reasons why urban dwellers would be more willing to screen compared to rural dwellers. Further investigation might be required to understand the reasons for that. This study was strengthened by the presence of limited missing observations. Furthermore, the use of female interviewers who were staffs of the hospital allowed the patient's full disclosure of all required information. This study has identified some gaps with respect to education and awareness which was possible because the research team constitutes members of the care team in the clinic. Even though the media in Dodoma have proven to reliably reach out to patients on cervical cancer, better education can only be done by the hospital.
It is understandable that the high patients to staff ratio at the HIV site might not allow time for educating patients on cervical cancer due to but posters on the walls of the HIV clinic and other educational materials given to the patients at visits could be a good strategy to start educating the patients. A limitation of this study was interviewed bias. Possibilities are that some of the participant's responses might have favored the body language or tone of the interviewers.
Even though the interviewers were trained sufficiently to eliminate such biases there are still possibilities of influences of participant's responses by the interviewer's outlook. Some of the participants who have good knowledge of mobile phones answered the survey themselves and those without good knowledge of mobile phones were helped by the research assistants. This could impact our results because we did not track if there is a difference between the method of survey administration. It is therefore recommended that future studies should allow a more comprehensive approach to understanding cervical cancer screening at HIV CTC, DRRH Dodoma which should include the care team in the survey to determine the potential barriers to uptake of cervical cancer screening from provider’s perspectives.
Cervical Cancer Screening Among Women Receiving . (2022, Jan 06). Retrieved from https://studymoose.com/cervical-cancer-screening-among-women-receiving-essay
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