Pierz Amanda J, Ajeh Rogers, Fuhngwa Norbert, Nasah Judith, Dzudie Anastase, Nkeng Relindis, Anastos Kathryn M, Castle Philip E, Adedimeji Adebola
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon.
Front Reprod Health. 2021 Jan 14;2:561202. doi: 10.3389/frph.2020.561202. eCollection 2020.
Like many countries in Sub-Saharan Africa, Cameroon has a high burden of cervical cancer and low availability and uptake of screening. Self-collection has the potential to increase the uptake of cervical cancer screening among Cameroon women. This paper explores patient and community insights surrounding self-collection among women living with HIV and HIV[-] women as well as the barriers and facilitators to obtaining and utilizing self-collected specimens in cervical cancer screening programs. We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews during data collection that took place from May to August 2018. A two-stage sampling strategy was used to select 80 women who participated in six focus group discussions and eight in-depth interviews. We utilized the socio-ecological framework to guide data analysis. All participants indicated that self-sampling was an acceptable method of specimen collection and should be offered as an option for cervical cancer screening in Cameroon. Whereas, most women, regardless of HIV status, preferred the option for self-collection, barriers were identified, such as lack of education about self-collection procedure, being uncomfortable, embarrassed or in pain from the procedure, fear of consequences, perceived competence about ability to self-collect and privacy and confidentiality. We also found that HIV-related stigma was a major concern for HIV[-] women that could prevent them from accessing cervical cancer screening integrated within HIV treatment settings. To promote self-collection for cervical cancer screening, educational interventions with both patients and providers are necessary to increase knowledge of and overall willingness to utilize self-collection. Further research is recommended to examine the role of stigma for HIV[-] women in screening locations associated with HIV treatment.
与撒哈拉以南非洲的许多国家一样，喀麦隆宫颈癌负担沉重，筛查服务的可及性和接受率较低。自我采样有可能提高喀麦隆女性宫颈癌筛查的接受率。本文探讨了艾滋病病毒感染者和未感染艾滋病病毒的女性对自我采样的患者及社区见解，以及在宫颈癌筛查项目中获取和使用自我采集样本的障碍与促进因素。我们采用探索性定性研究方法，通过2018年5月至8月的数据收集期间进行的焦点小组讨论和深入访谈来获取数据。采用两阶段抽样策略选取了80名女性，她们参与了6次焦点小组讨论和8次深入访谈。我们利用社会生态框架来指导数据分析。所有参与者均表示自我采样是一种可接受的样本采集方法，应作为喀麦隆宫颈癌筛查的一种选择提供给女性。然而，尽管大多数女性，无论艾滋病病毒感染状况如何，都倾向于自我采样这一选择，但仍发现了一些障碍，如缺乏关于自我采样程序的教育、对该程序感到不适、尴尬或疼痛、担心后果、对自我采样能力的认知不足以及隐私和保密问题。我们还发现，与艾滋病相关的污名化是未感染艾滋病病毒女性的一个主要担忧，这可能会阻止她们在艾滋病治疗场所接受宫颈癌筛查。为促进宫颈癌筛查的自我采样，有必要对患者和医护人员进行教育干预，以增加对自我采样的了解和总体使用意愿。建议进一步开展研究，以考察污名化对未感染艾滋病病毒女性在与艾滋病治疗相关的筛查场所中的影响。
