Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda.
BMC Health Serv Res. 2023 Apr 3;23(1):333. doi: 10.1186/s12913-023-09326-6.
Integrating cervical cancer screening into routine Human Immunodeficiency Virus (HIV) care has been endorsed as an effective strategy for increasing uptake of cervical cancer screening, facilitating early detection and treatment of pre-cancerous lesions among HIV-infected women. In Uganda, this strategy has not been implemented yet in most HIV clinics. Assessing acceptability of this intervention among HIV-infected women is of great relevance to inform implementation. We assessed acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women enrolled in the HIV clinic at Mbarara Regional Referral Hospital.
A mixed methods study utilizing explanatory sequential approach was conducted among 327 eligible HIV-infected women. Acceptability of integration of cervical cancer screening into routine HIV care was measured based on Theoretical Framework of Acceptability. Quantitative data was collected using a pre-tested questionnaire. We conducted focus group discussions to explore perceptions regarding the intervention among purposively selected HIV-infected women. Modified Poisson regression with robust variance analysis was utilized to determine factors associated with acceptability of the intervention. Statistical significance was determined at p-value <0.05. Thematic analysis utilizing inductive coding was applied to analyse qualitative data.
The majority of HIV-infected women (64.5%) accepted integration of cervical cancer screening into routine HIV care. Religion, perceived risk of developing cervical cancer and ever screened for cervical cancer were statistically significantly associated with acceptability of integration of cervical cancer screening into routine HIV care. Perceived benefits of the proposed intervention were: convenience to seek for cervical cancer screening, motivation to undergo cervical cancer screening, improved archiving of cervical cancer screening results, confidentiality of HIV patient information, and preference to interact with HIV clinic health workers. Shame to expose their privacy to HIV clinic health workers and increased waiting time were the only perceived challenges of the integrated strategy.
Study findings highlight the need to take advantage of this acceptability to prioritize implementation of integration of cervical cancer screening into routine HIV care. HIV-infected women should be reassured of confidentiality and reduced waiting time to increase uptake of integrated cervical cancer screening and HIV services among HIV-infected women along the continuum of HIV care and treatment services.
将宫颈癌筛查纳入常规人类免疫缺陷病毒（HIV）护理已被认可为增加宫颈癌筛查率的有效策略，有助于在感染 HIV 的女性中及早发现和治疗癌前病变。在乌干达，大多数 HIV 诊所尚未实施这一策略。评估感染 HIV 的女性对这一干预措施的接受程度对于提供实施依据非常重要。我们评估了 Mbarara 地区转诊医院 HIV 诊所招募的 HIV 感染女性对将宫颈癌筛查纳入常规 HIV 护理的接受程度、相关因素和看法。
采用解释性顺序方法对 327 名符合条件的 HIV 感染女性进行了一项混合方法研究。基于可接受性理论框架评估将宫颈癌筛查纳入常规 HIV 护理的可接受性。使用经过预测试的问卷收集定量数据。我们进行了焦点小组讨论，以探索有针对性选择的 HIV 感染女性对该干预措施的看法。使用修正泊松回归分析和稳健方差分析确定与该干预措施可接受性相关的因素。p 值 <0.05 为统计学显著。采用归纳编码的主题分析方法对定性数据进行分析。
大多数 HIV 感染女性（64.5%）接受将宫颈癌筛查纳入常规 HIV 护理。宗教、对宫颈癌发病风险的认知和曾接受过宫颈癌筛查与接受将宫颈癌筛查纳入常规 HIV 护理的可接受性呈统计学显著相关。对拟议干预措施的益处的认识包括：寻求宫颈癌筛查的便利、接受宫颈癌筛查的动力、改善宫颈癌筛查结果的归档、HIV 患者信息的保密性以及与 HIV 诊所卫生工作者互动的偏好。对 HIV 诊所卫生工作者暴露隐私的羞耻感和增加的等待时间是整合策略的唯一感知挑战。
研究结果强调需要利用这种可接受性来优先实施将宫颈癌筛查纳入常规 HIV 护理。应向 HIV 感染女性保证保密性和减少等待时间，以增加感染 HIV 的女性在 HIV 护理和治疗服务连续体中对整合宫颈癌筛查和 HIV 服务的接受程度。
