Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment

Lieber, Molly; Afzal, Omara; Shaia, Kathryn L.; Mandelberger, A; Preez, Christine Du; Beddoe, Ann Marie

doi:10.5334/aogh.37

Cited by 10 publications

(14 citation statements)

References 17 publications

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“…Four studies included men [33,60,63,87] and in two of the studies, they were partners of women participants [33,63] while in the others they were university male students. Thirteen studies included healthcare workers exclusively or with non-healthcare workers [13,14,24,35,37,41,47,54,55,73,82,85,86]. Eight studies included participants younger than 18 years old including one study that included girls from the age of 10 years together with older women [15,17,26,32,34,49,58, 87] -36.…”

Section: Google Scholar 18mentioning

confidence: 99%

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Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

et al. 2022

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Objectives Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. Design This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. Setting We included studies conducted in LMICs published in English between 2010 and 2020. Participants We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. Results Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. Conclusion A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women’s health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

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Section: Google Scholar 18mentioning

confidence: 99%

“…Frequently missing information was age of the participants, type of screening and when the study was conducted. The sample sizes of studies ranged from 15 participants [24,48,54] to 15,317 participants in a study that analysed secondary data [26].…”

Section: Google Scholar 18mentioning

confidence: 99%

Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

et al. 2022

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“…The inclusion of formal or informal peer support or networking to foster ongoing learning following TTT programs were common in the literature. 14,18,22,28,29 In a RCT that utilised TTT to support middle-cadre health care workers in Malawi to deliver a lung health plus HIV/AIDS intervention, Sodhi et al 18 reported that the ability to contact more experienced peers for advice when unsure how to manage a patient through formal and informal networks supported sustained trainer engagement. Continuous education was described as essential for sustainability of a HIV education TTT program for nurses, as the field of HIV nursing rapidly evolves and staying up to date with the most recent international developments is crucial for providing care.…”

Section: Sustainabilitymentioning

confidence: 99%

Sexual and reproductive health “Train The Trainer” programs in low- and middle-income countries: a scoping review

Hughes

Botfield

McGeechan

2021

Journal of Global Health Reports

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BackgroundUniversal access to reproductive health care including family planning and sexual health care are recognised as human rights and are a key contributor to the United Nations' (UN) Sustainable Development Goals, yet many people across the globe have limited access to information and services to protect their sexual and reproductive health (SRH). Universal access cannot be achieved without a skilled health workforce. 'Train the Trainer' (TTT) approaches are commonly advocated as cost-effective and sustainable options for building health capacity through up-skilling health workforces. MethodsA scoping review was undertaken to identify the type and extent of the available literature on sexual and reproductive health TTT programs in low-and middle-income (LMI) countries, in order to gain insights to inform practice and fill the knowledge gaps to inform future research. Six databases were used as the source of information (CINAHL, EMBASE, ERIC, Global Health, Medline and Scopus). ResultsA systematic search returned a total of 700 studies. After duplicate removal, 487 studies were screened by year, title and abstract, and 39 studies were identified for full text review. After the full text review, 16 studies were deemed to meet the criteria for final inclusion. Findings show that much of the published literature on SRH TTT programs reports on HIV training in African countries. Thematic analysis revealed a wealth of practical considerations for practitioners wishing to implement SRH TTT programs in LMI country settings. ConclusionsThis scoping review identified a paucity of recent peer-reviewed literature available on SRH TTT programs in LMI country settings. Despite this, a number of practical considerations remain, relating to TTT methodology and design; factors that support or inhibit implementation; and sustainability and scaling up were identified. Future research should focus on adopting stronger outcome evaluation methodology to determine effectiveness of TTT programs; and investigate the application of TTT models across a range of SRH topics in a diverse range of LMI countries.

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Section: Introductionmentioning

confidence: 99%

“…Thus, there is a regular need to undergo cervical cancer screening (CCS) among HIV-positive women. In South Africa, several studies examining CCS among HIV-positive women have been conducted with varying ndings (5, 6,7, 8,9). The studies found that the factors associated with CCS among HIV-positive women include race, age, nationality, geography, marriage, educational attainment, cigarette smoking, and employment.However, these studies have had a limited geographic scope, often focusing on hospitals, clinics, and provinces in an isolated manner, making it impossible to generalize studies nationally and provide country-wide policy recommendations to improve the uptake of CCS among WLHIV.…”

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confidence: 99%

Cox proportional hazard-model application: Time to cervical cancer screening among women living with HIV in South Africa

Hollington

2023

Preprint

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Background There is an increased risk of cervical cancer among women living with HIV. While studies have long examined the association between cervical cancer among women with HIV, no study has examined the time taken for women with HIV to undergo cervical cancer screening as well as the hazard thereof in South Africa. Methods The study used cross-sectional data from the 2016 South Africa Demographic and Health Survey. To allow for longitudinal analysis and to address the issue of right-censoring, the data was reformatted to a person-data file. The selection criteria were limited to women living with HIV (WLHIV) who had also responded to the question on cervical cancer screening. Descriptive statistics were employed to show the levels of HIV among women aged 15 and older in South Africa. Additionally, Kaplan‒Meier curves were employed to investigate the time to CCS by WLHIV in South Africa. Thereafter, an unadjusted Cox hazards regression model was employed to examine the hazard of undergoing CCS among WLHIV. Last, it employed an adjusted model to examine the hazard of CCS among WLHIV while adjusting for other factors. Results Nineteen percent (n = 1,159) of the women who participated in the study tested positive for HIV. Herein, it was found that the risk of CCS among WLHIV began at the age of approximately 19 years. Thereafter, the hazard of undergoing CCS among WLHIV began to decrease at 58 years. There was a significant association between CCS and WLHIV. Additionally, several covariates were found to be significantly associated with HIV. These were race, province, area of residence, marriage, educational attainment, employment, alcohol consumption, perceived health perception, and health insurance. Conclusion The hazard of CCS was lower among WLHIV compared to WLHIV who did not undergo CCS in South Africa. This puts HIV-positive women at risk of increased morbidity and mortality from potential cervical cancer and HIV comorbidity due to CCS deficits within this group, as they are susceptible to HPV and subsequent cervical cancer due to a compromised immune system. HIV-positive women need to routinely undergo CCS every 12 months from baseline for 3 years. Thereafter, they should undergo CCS once every 3 years to reduce their risk of developing the disease.

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Cervical Cancer Screening in HIV-Positive Farmers in South Africa: Mixed-Method Assessment

Cited by 10 publications

References 17 publications

Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

Sexual and reproductive health “Train The Trainer” programs in low- and middle-income countries: a scoping review

Cox proportional hazard-model application: Time to cervical cancer screening among women living with HIV in South Africa

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