Nega Abebe Dires, Woldetsadik Mulat Adefris, Gelagay Abebaw Addis
Gondar University Hospital, Gondar City, Ethiopia.
College of Medicine and Health Science, Gynecology and Obstetrics Department, University of Gondar, Gondar City, Ethiopia.
BMC Womens Health. 2018 Jun 7;18(1):87. doi: 10.1186/s12905-018-0579-z.
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.
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.
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.
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.
宫颈癌是全球女性主要死因之一。大多数病例发生在发展中国家。人类免疫缺陷病毒（HIV）阳性女性中宫颈癌死亡风险增加以及人乳头瘤病毒（HPV）感染率高，这就需要确定癌前宫颈癌（Ca）筛查的接受程度。因此，本研究旨在评估宫颈癌筛查的接受情况及其相关因素。
2016年4月至5月，在贡德尔大学转诊医院接受护理和治疗的成年HIV阳性女性中进行了一项基于机构的横断面研究。数据通过访谈员管理的问卷收集。采用双变量和多变量逻辑回归分析来确定因变量和自变量之间的关联存在情况及程度。在多变量逻辑分析中，P值<0.05且具有95%置信区间的比值比被用于确定宫颈癌（Ca）筛查接受情况的独立预测因素。
HIV阳性女性中宫颈癌筛查的终生接受率为10%（95%置信区间（CI）：7.3 - 12.8）。在多变量分析中，接受小学教育的女性（调整后比值比（AOR） = 3.92，95%CI：1.70 - 8.99）、接受中学教育的女性（AOR = 3.84，95%CI：1.50 - 9.83）、接受高等教育的女性（AOR = 4.16，95%CI：1.24 - 13.98）、育有子女的女性（AOR = 3.02，95%CI：1.23 - 7.46）、十年或更早被诊断为HIV阳性的女性（AOR = 2.71，95%CI：1.06 - 6.97）以及细胞分化4（CD4）计数小于或等于200个细胞/mm³的女性（AOR = 5.29，95%CI：2.58 - 10.83）与宫颈癌筛查的接受情况显著相关。
在本研究中，宫颈癌筛查的接受率非常低。教育程度、生育状况、HIV阳性诊断后的时间长度以及CD4计数是宫颈癌筛查的重要预测因素。医护人员以及宫颈癌预防和控制项目的协调员和实施者需要为所有接受抗逆转录病毒治疗（ART）护理的人员提供咨询服务。为了探究宫颈癌Ca筛查癌前阶段服务利用率低的根本原因，必须开展一项包含定性部分的供给侧研究。
