Cervical Cancer Screening Uptake Among HIV Positive Women Seeking Healthcare Services At A Tertiary Hospital In Lusaka, Zambia.

Authors: Dr Mwansa K Lubeya,(UNZA, YES) Paddy Chima (UNZA, YES) Christabel Phiri (LMTH, YES) Jane Kabwe (MIE, YES)and Mukatimui Kalima-Munalula(WNH, YES)

Download Pdf

Citation Style For This Article: Lubeya MK, Chima P, Phiri C, et al. Cervical Cancer Screening Uptake Among HIV Positive Women Seeking Healthcare Services At A Tertiary Hospital In Lusaka, Zambia.. Health Press Zambia Bull. 2020; 4(4); pp 16

Background

Cervical cancer affects the female genital tract and is one of the commonest cancers caused by the Human papillomavirus (HPV). In 2018 alone, approximately 311,000 women died from cervical cancer across the globe, with over 500,00 living with the disease. Zambia has one of the highest age-standardized cervical cancer incidence and mortality at 44.6/100000 and 66.3/100000 women-years respectively. The disparities in disease occurrences are mainly due to poor implementation and lack of readily available services for cervical cancer screening in many African countries. Additionally, the high burden of HIV sub-Sahara Africa makes women more vulnerable to developing cervical cancer. The Zambia population HIV report of 2018 indicates a national HIV prevalence of 12%; however, when stratified by sex, prevalence is 14.6% in women and 9.3% in men. Zambia has run one of the most successful mass cervical cancer screening programs in sub-Saharan Africa, with a significant focus on HIV-positive women since 2006. This study was aimed at understanding the uptake of cervical screening among HIV-positive women at a tertiary hospital through a cross-sectional study.

Methods

This was a cross-sectional study among women admitted to the medical ward of the Adult hospital of the University Teaching Hospitals in Lusaka, Zambia. Using a structured questionnaire data was collected for social demographics, cervical cancer practices, and social influences.

Results

A total of 268 women aged between 25 and 70 were interviewed. The mean age of the participants was 41, the majority of the participants were Lusaka residents, 133 (49 %) were HIV positive, while 137 (51%) were HIV negative. Among the participants,116 (43%) had screened for cervical cancer, and of those screened, 77% were HIV positive. In the bivariate analysis, older women (p=0.012), Lusaka residents (0.018) HIV positive women (P<0.0001), those who understood the screening eligibility (0.036), and knew about the Human papillomavirus vaccine(p<0.0001) had significantly higher uptake of screening services. There was no significant association between level of education and occupation. The Anti-retroviral therapy clinic was the most typical source of information on cervical cancer. In multivariate logistic regression, age (OR 1.1, 95% CI 1.0-1.1), knowledge of screening eligibility (OR 1.2, 95% CI 1.06-1.14), and HIV status (OR 15.8, 95% CI 7.2-34.5) remained significant predictors of cervical cancer screening uptake.

Discussion & Conclusion

Positive women in a medical admission are more likely to have screened for cervical cancer; this is an excellent milestone for Zambia considering the increased risk for this population to die from cervical cancer. However, HIV-negative women should also be encouraged to screen as there are other risk factors associated with cervical cancer besides HIV infection. Despite this study being conducted at one tertiary hospital, women came from various parts of the country seeking different medical services; hence results may be considered as being representative of the national situation.

Keywords: Cervical cancer, HIV, Zambia, uptake, screening, Zambia

Key Messages

1. The complimentary messages on the importance of screening for high-risk HIV positive women are yielding results

2. Efforts to encourage all women to screen regardless of HIV status should continue

3. Cervical cancer screening messages should be intensified in other provinces outside Lusaka