Harder Michelle T, Mokete Moliehi, Chammartin Frédérique, Lerotholi Malebanye, Motaboli Lipontso, Kopo Mathebe, Kao Mpho, Mokebe Moleboheng, Chejane Ntoiseng, Mahlatsi Palesa, Nyakane Morongoe, Tarumbiswa Tapiwa, Labhardt Niklaus D, Tschumi Nadine, Belus Jennifer M
Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Totengässlein 3, Basel, 4051, Switzerland.
University of Basel, Basel, Switzerland.
BMC Womens Health. 2024 Oct 1;24(1):543. doi: 10.1186/s12905-024-03382-8.
Cervical cancer is the fourth most common cancer in women worldwide, and women with human immunodeficiency virus (HIV) are particularly at risk of developing it. Regular screening effectively prevents morbidity and mortality. This mixed-methods study quantitatively assessed cervical cancer screening uptake and qualitatively explored the process of undergoing cervical cancer screening to understand possible reasons for delayed screening among women with HIV in Lesotho.
Between October 2020 and March 2022, the Viral load Triggered ART care in Lesotho (VITAL) trial enrolled women aged 18 years and older with HIV who were taking antiretroviral therapy (ART). Cervical cancer screening delay was defined as reporting a screening that occurred more than two years ago or never having been screened. Cervical cancer screening uptake and the association between screening delay and sociodemographic variables were assessed using a multivariable mixed-effects logistic regression model accounting for clustering at clinic level. In-depth interviews were conducted with 16 women to obtain information on awareness, perceptions, and barriers to cervical cancer screening and were analyzed using thematic analysis.
Quantitative data were available for 3790 women. Among them, cervical cancer screening was delayed in 1814 (47.9%), including 1533 (40.5%) who were never screened. Compared to women aged 25 to 39 years, women aged 18 to 24 years (adjusted odds ratio (aOR) 2.8; 95% confidence interval (CI) 2.1-3.7), women aged 40 to 59 years (aOR 1.3; CI 1.1-1.6), and women older than 60 years (aOR 3.9; CI 3.0-5.1) were at higher risk of screening delay. Furthermore, time on ART below 6 months (aOR 1.6; CI 1.1-2.3) compared to above 6 months was associated with screening delay. Qualitative data identified limited awareness of cervical cancer risks and screening guidelines, misconceptions and fears created by the influence of other women's narratives, and low internal motivation as the main barriers to screening uptake.
Cervical cancer screening delay was common. Limited personal awareness and motivation as well as the negative influence of other women were the primary internal barriers to cervical cancer screening. Awareness and screening campaigns in Lesotho should consider these factors.
clinicaltrials.gov, NCT04527874, August 27, 2020.
宫颈癌是全球女性中第四大常见癌症，感染人类免疫缺陷病毒（HIV）的女性尤其有患宫颈癌的风险。定期筛查可有效预防发病和死亡。这项混合方法研究定量评估了宫颈癌筛查的接受情况，并定性探索了接受宫颈癌筛查的过程，以了解莱索托感染HIV的女性筛查延迟的可能原因。
2020年10月至2022年3月期间，莱索托病毒载量触发抗逆转录病毒治疗护理（VITAL）试验纳入了年龄在18岁及以上且正在接受抗逆转录病毒治疗（ART）的感染HIV的女性。宫颈癌筛查延迟定义为报告的筛查发生在两年多以前或从未接受过筛查。使用考虑诊所层面聚类的多变量混合效应逻辑回归模型评估宫颈癌筛查的接受情况以及筛查延迟与社会人口统计学变量之间的关联。对16名女性进行了深入访谈，以获取有关宫颈癌筛查的意识、认知和障碍的信息，并使用主题分析进行分析。
有3790名女性的定量数据可用。其中，1814名（47.9%）女性的宫颈癌筛查延迟，包括1533名（40.5%）从未接受过筛查的女性。与25至39岁的女性相比，18至24岁的女性（调整后的优势比（aOR）为2.8；95%置信区间（CI）为2.1 - 3.7）、40至59岁的女性（aOR为1.3；CI为1.1 - 1.6）以及60岁以上的女性（aOR为3.9；CI为3.0 - 5.1）筛查延迟的风险更高。此外，与接受ART时间超过6个月相比，接受ART时间低于6个月（aOR为1.6；CI为1.1 - 2.3）与筛查延迟有关。定性数据表明，对宫颈癌风险和筛查指南的认识有限、其他女性叙述的影响所产生的误解和恐惧以及内在动力不足是筛查接受的主要障碍。
宫颈癌筛查延迟很常见。个人意识和动力有限以及其他女性的负面影响是宫颈癌筛查的主要内在障碍。莱索托的意识和筛查活动应考虑这些因素。
clinicaltrials.gov，NCT04527874，2020年8月27日。
