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      Low uptake of cervical cancer screening among HIV positive women in Gondar University referral hospital, Northwest Ethiopia: cross-sectional study design

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          Abstract

          Background

          Cervical cancer is one of the leading causes of death in women worldwide. Majority of the cases are found in developing countries. The increasing risk of cervical cancer death and the high prevalence of human papilloma virus (HPV) infection in Human immuno-deficiency virus(HIV) positive women calls for determining the level of premalignant cervical cancer (Ca) screening uptake. So, this study aimed to assess the uptake of cervical cancer screening and its associated factors.

          Methods

          An institution based cross sectional study was conducted from April to May, 2016, among adult HIV positive women attending care and treatment at Gondar University Referral Hospital. The data were collected using an interviewer administered questionnaire.

          Bivariate and multivariable logistic regression analyses were used to determine the presence and the degree of association between dependent and independent variables. In the multivariable logistic analysis, a P-value of < 0.05 and odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer(Ca) screening.

          Results

          The life-time uptake of cervical cancer screening among HIV positive women was 10% (95% Confidence Interval(CI): 7.3–12.8). In multivariable the analysis, women with primary education (Adjusted Odds Ratio(AOR) = 3.92, 95%CI:1.70–8.99), secondary education (AOR = 3.84, 95%CI: 1.50–9.83), and tertiary level education (AOR = 4.16, 95%CI: 1.24–13.98), having a child (AOR = 3.02, 95%CI: 1.23–7.46), diagnosed as HIV positive ten years back or more (AOR = 2.71, 95% CI: 1.06–6.97), and Cell Differentiation 4(CD4) count of less than or equal to 200cell/mm3 (AOR = 5.29, 95% CI: 2.58–10.83) were significantly associated with the uptake of cervical cancer screening.

          Conclusion

          In this study, the uptake of cervical cancer screening was very low. Educational status, parity, length of time after diagnosis as HIV positive, and CD4 count are important predictors of cervical cancer screening. Health care workers and cervical cancer prevention and control program coordinators and implementers need to provide counseling services for all Anti-retroviral Therapy(ART) care attendants. So as to explore the root causes for the low utilization of precancerous stage of cervical Ca screening service, conducting a study on the supply side with a qualitative component is mandatory.

          Electronic supplementary material

          The online version of this article (10.1186/s12905-018-0579-z) contains supplementary material, which is available to authorized users.

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          Most cited references 9

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          Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

          Background The proven benefit of integrating cervical cancer screening programme into HIV care has led to its adoption as a standard of care. However this is not operational in most HIV clinics in Nigeria. Of the various reasons given for non-implementation, none is backed by scientific evidence. This study was conducted to assess the willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. Methods A cross sectional study of HIV positive women attending a large HIV treatment centre in Lagos, Nigeria. Respondents were identified using stratified sampling method. A pretested questionnaire was used to obtain information by trained research assistants. Obtained information were coded and managed using SPSS for windows version 19. Multivariate logistic regression model was used to determine independent predictor for acceptance of cervical cancer screening. Results Of the 1517 respondents that returned completed questionnaires, 853 (56.2%) were aware of cervical cancer. Though previous cervical cancer screening was low at 9.4%, 79.8% (1210) accepted to take the test. Cost of the test (35.2%) and religious denial (14.0%) were the most common reasons given for refusal to take the test. After controlling for confounding variables in a multivariate logistic regression model, having a tertiary education (OR = 1.4; 95% CI: 1.03-1.84), no living child (OR: 1.5; 95% CI: 1.1-2.0), recent HIV diagnosis (OR: 1.5; 95% CI: 1.1-2.0) and being aware of cervical cancer (OR: 1.5; 95% CI: 1.2-2.0) retained independent association with acceptance to screen for cervical cancer. Conclusions The study shows that HIV positive women in our environment are willing to screen for cervical cancer and that the integration of reproductive health service into existing HIV programmes will strengthen rather than disrupt the services.
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            Willingness and acceptability of cervical cancer screening among women living with HIV/AIDS in Addis Ababa, Ethiopia: a cross sectional study

            Background In Ethiopia, cervical cancer (CC) ranks the 2nd most frequent cancer and the country had 27.19 million women at risk of developing the disease though only 0.6 % women age 18-69 years was screened every 3 years. Nearly a quarter (22.1 %) of southern Ethiopia HIV (Human Immunodeficiency Virus) infected Women were positive for precancerous cervical cancer. Doing regular screening can prevent the disease by around half (45 %) of the cases in age of 30s and three quarter (75 %) cases in 50s and 60s.In the presence of high risk for acquiring cervical cancer among HIV patients, willingness and acceptance of the screening is low in Addis Ababa, Ethiopia thus the current study was aimed to assess willingness and acceptability of cervical cancer screening and its determinants among women living with HIV/AIDS in Addis Ababa, Ethiopia. Method A facility based cross sectional study was conducted among HIV positive women attending HIV treatment centers in Addis Ababa. The respondents were identified using systematic random sampling method. Data was collected using pretested questionnaire and were entered in to Epi-info version 3.5.1 software and exported in to SPSS version 20 statistical package for analysis. The criterias for entering independent variables into multivariate analysis were having p-value 0.05 or less at bivariate analysis and not co-linear. Result One third (34.2 %) of participants knew cervical cancer and two third (62.7 %) were willing for the test though only a quarter (24.8 %) were accepted the test. The independent variables significantly associated with acceptance of screening were educational level, source of information, awareness for the test and preventability of the disease. Conclusion In current study willingness and acceptance of CC (cervical cancer) were low thus organizations working on cancer and HIV/AIDS should establish cervical cancer screening program and further enhance awareness creation.
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              Cervical Cancer Screening Knowledge and Behavior among Women Attending an Urban HIV Clinic in Western Kenya.

              Cervical cancer is a highly preventable disease that disproportionately affects women in developing countries and women with HIV. As integrated HIV and cervical cancer screening programs in Sub-Saharan Africa mature, we have an opportunity to measure the impact of outreach and education efforts and identify areas for future improvement. We conducted a cross-sectional survey of 106 women enrolled in care at an integrated HIV clinic in the Nyanza Province of Kenya 5 years after the start of a cervical cancer screening program. Female clinic attendees who met clinic criteria for cervical cancer screening were asked to complete an oral questionnaire assessing their cervical cancer knowledge, attitudes, and screening history. Ninety-nine percent of women had heard of screening, 70 % felt at risk, and 84 % had been screened. Increased duration of HIV diagnosis was associated with feeling at risk and with a screening history. Nearly half (48 %) of women said they would not get screened if they had to pay for it.
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                Author and article information

                Contributors
                abede9907@gmail.com
                mulatadefrisw@gmail.com
                abebaw.addis@gmail.com
                Journal
                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central (London )
                1472-6874
                7 June 2018
                7 June 2018
                2018
                : 18
                Affiliations
                [1 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, Gondar University Hospital, ; Gondar City, Ethiopia
                [2 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, College of Medicine and Health Science, Gynecology and Obstetrics Department, , University of Gondar, ; Gondar City, Ethiopia
                [3 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, College of Medicine and Health Science, Reproductive Health Department, , University of Gondar, ; Gondar City, Ethiopia
                Article
                579
                10.1186/s12905-018-0579-z
                5992703
                29879969
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology

                ethiopia, cervical cancer, screening, hiv positive women

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