医疗提供者和女性对改善 Mbarara 地区转诊医院中 HIV 感染者的宫颈癌筛查的机会、挑战和建议的看法：一项定性研究。

Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study.

机构信息

Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.

Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda.

出版信息

BMC Womens Health. 2024 Jul 8;24(1):392. doi: 10.1186/s12905-024-03239-0.

DOI:10.1186/s12905-024-03239-0

PMID:38978020

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11229203/

Abstract

BACKGROUND

Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death.

OBJECTIVE

We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda.

METHODS

In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis.

RESULTS

The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake.

CONCLUSION

Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.

摘要

背景

尽管宫颈癌筛查是成年 HIV 感染者（WLHIV）的重要预防方法，但筛查率仍然很低。这些女性 HPV 高危型感染和持续感染以及严重后果（包括宫颈癌合并症和死亡）的发生率更高。

目的

我们旨在探索乌干达西南部提高 WLHIV 宫颈癌筛查率的临床医护人员和 WLHIV 的机会、挑战和建议。

方法

本研究于 2021 年 1 月至 6 月在姆巴拉拉地区转诊医院进行，采用横断面定性研究，对 6 名关键知情人医护人员进行访谈，并与 4 组 HIV 感染者进行焦点小组讨论。使用 Atlas ti 软件对数据进行编码，并采用主题归纳分析法进行分析。

结果

参与者确定了一些有利于宫颈癌筛查的机会，包括熟练的临床医护人员、公众对需求创造的认识、优化的诊所流程、以提供者为主导的转介以及同伴主导的信息共享，这些都可以方便诊所就诊流程并缩短患者就诊时间。然而，也存在一些挑战，如独立服务导致双重排队、就诊时间延长、由于缺乏支持的基层卫生机构，导致错过在基层卫生机构筛查的机会，使转诊医院人满为患、以及患者隐私措施不足导致羞辱和耻辱感以及对宫颈癌不可治愈的误解。将 HPV-DNA 检测纳入 HIV 服务存在分歧，一些参与者担心样本采集的质量，而另一些人则重视其提供的隐私。优化自我采集 DNA 检测和充分咨询被推荐用于提高宫颈癌筛查率。

结论

宫颈癌筛查的机会包括经过培训的临床医护人员、提高公众意识、改善诊所流程、提供转诊服务和同伴教育。还存在一些挑战，如缺乏支持的基层卫生机构、误解、患者隐私不足以及对将 HPV-DNA 筛查纳入 HIV 服务的不确定性。建议提供充分的咨询和自我采样以促进筛查。我们的研究结果可能为将宫颈癌筛查纳入 HIV 诊所的医疗保健项目提供指导，以实现 2030 年世卫组织 70%的目标。