Acceptability of HPV screening among HIV-infected women attending an HIV-dedicated clinic in Abidjan, Côte d’Ivoire

Abstract

Background: Cervical cancer incidence is high among women living with HIV due to high-risk HPV persistence in the cervix. In low-income countries, cervical cancer screening is based on visual inspection with acetic acid. Implementing human papilloma virus (HPV) screening through self-sampling could increase women's participation and screening performance. Our study aims to assess the preintervention acceptability of HPV screening among HIV-infected women in Abidjan, Côte d'Ivoire. Methods: Applying the Health Belief Model theoretical framework, we collected qualitative data through in-depth interviews with 21 HIV-infected women treated in an HIV-dedicated clinic. Maximum variation sampling was used to achieve a diverse sample of women in terms of level of health literacy. Interviews were recorded and transcribed with the participants' consent. Data analysis was performed using NVivo 12. Results: Screening acceptability relies on cervical cancer representations among women. Barriers were the fear of diagnosis and the associated stigma disregard for HIV-associated health conditions, poor knowledge of screening and insufficient resources for treatment. Fees removal, higher levels of knowledge about cervical cancer and of the role of HIV status in cancer were found to facilitate screening. Healthcare providers are obstacle removers by their trusting relationship with women and help navigating through the healthcare system. Self-confidence in self-sampling is low. Conclusions: Free access to cervical screening, communication strategies increasing cervical cancer knowledge and healthcare provider involvement will foster HPV screening. Knowledge gathered through this research is crucial for designing adequate HPV-based screening interventions for women living with HIV in this setting.

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

“…The majority of studies were conducted using quantitative methods (six were cross-sectional studies [ 47 , 48 , 49 , 50 , 51 , 52 ], three studies were quasi-experimental studies [ 41 , 45 , 53 ], and one was a prospective observational study [ 36 ]). Two were qualitative studies (interviews [ 46 , 54 ] and focus group discussion [ 46 ]), while one used mixed methods (i.e., focus group and survey [ 53 ]). Most of the cross-sectional studies involved short interventions or instructions where study participants received instructions about screening and/or about steps for using sampling kits [ 36 , 41 , 45 , 48 , 49 , 50 , 51 , 52 ].…”

“…The reviewed studies were implemented across eight LMICs, with most of the studies conducted in African countries, except for one that was conducted in Brazil [ 47 ]. Three studies were in Botswana [ 45 , 49 , 50 ], three in South Africa [ 36 , 41 , 51 ], and one each in Ghana [ 48 ], Côte d’Ivoire [ 54 ], Zimbabwe [ 52 , 53 ], and Uganda. Studies were generally similar in terms of study settings (clinics or hospitals) and recruitment methods (face-to-face).…”

Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial

“…A discrepancy between the acceptability of self-sampling and a lack of confidence to perform it has been described in prior studies on the acceptability of CC self-sampling among women living with HIV in Côte d'Ivoire, Kenya and Rwanda [39][40][41].…”

Cervical cancer prevention: Human papillomavirus testing as primary screening

“…The quality of self‐collected samples is comparable to clinician‐collected samples, 28‐33 and women also consider self‐collection to be acceptable, adequately private, and preferable over clinician‐collected sampling 20,30,34,35 . However, despite the general acceptance of self‐collection among women, lack of confidence in and awareness of HPV testing and self‐collection have also been reported in some contexts as barriers to screening uptake 16,27,36‐38 . Strategies such as having a health care worker present to facilitate and explain the procedure may provide assurance to women during self‐collection 34 .…”

“…Among women in LMICs, there is relatively low awareness of HPV and cervical cancer 41 . The word “cancer” incites stigma and fear because it is synonymous with severe illness or death, an additional burden for WLHIV, and embarrassment or discomfort with pelvic examinations has also been reported 36,41,42 . This fear and unawareness presents as a barrier to the uptake of cervical cancer screening and treatment services.…”