Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context

Abstract

Background Cervical cancer is a leading cause of death among Cameroon women. The burden of cervical cancer is in part traceable to the inadequate understanding of socio-contextual determinants of access to screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical cancer prevention in women at risk in a low-income, high HIV prevalence context. Methods We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews from May to August, 2018. A two-stage purposive sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided data analyses to identify micro-, meso-, and macro-level determinants of cervical cancer screening. Results Micro-level factors including lack of awareness and knowledge about cervical cancer, lack of access to information, excessive cost of cervical cancer screening, low risk perceptions, and poor health seeking behaviors were major barriers for women seeking cervical cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Macro-level barriers to cervical cancer screening included poorly equipped health facilities and a lack of national cancer prevention policies and programs. Conclusion In the context of the call for elimination of cervical cancer as a public health problem, our findings highlight challenges and opportunities that should be considered when implementing interventions to increase uptake of cervical cancer screening in low-middle income settings.

High-risk human papillomavirus detection in self-collected vaginal samples compared with healthcare worker collected cervical samples among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa

“…HICs have been able to reduce cervical cancer incidence and mortality; however, LMICs continue to bear the burden of the disease [16]. Furthermore, in HICs, HPV as the primary test for cervical cancer screening has gradually been introduced [17].…”

“…The Abbott RealTime High-Risk HPV assay (Abbott Molecular GmbH & Co. KG, Wiesbaden, Germany) is a real-time PCR assay that detects 14 hrHPV DNA (16,18,31,33,35,39,45,51,52,56,58,59, 66 and 68) and genotypes only HPV types 16 and 18 from the other 12 hrHPV (non-HPV 16/18) types. A volume of 800 µL of healthcare worker and self-collected samples was transferred into Abbott m2000 Master-Mix tubes, respectively, and loaded into the Abbott m2000sp (Sample Preparation) system for extraction using the mSample Preparation System DNA kit.…”

“…An aliquot of 1 mL was transferred from the ThinPrep vial container to an Aptima Specimen Transfer tube containing the medium and tested using APTIMA ® HPV assay (Hologic Gen-Probe, Inc., San Diego, Canada) according to the manufacturer's instructions. The APTIMA ® HPV assay is a target amplification nucleic acid probe test for the in vitro qualitative detection of E6/E7 mRNA from 14 hrHPV types (16,18,31,33,35,39, 45, 51, 52, 56, 58, 59, 66 and 68). The assay did not discriminate between the 14 high-risk types, and the assay results were interpreted based on the signal/cutoff ratio for the analyte.…”

Knowledge, perception of HIV symptom severity and cervical cancer screening behaviour among women living with HIV in China

“…A body of literature supported the fear of discrimination as an important barrier for health-seeking behaviour among the HIV-positive population (Ongtengco et al, 2020). Women living with HIV refuse to participate in community or workplace-organised health-examination programmes because of fear of moral judgement (Adedimeji et al, 2021). This observation was consistent with the finding in the current study that reasons reported by non-screened women for not being screened included 'medical discrimination' and 'being worried T A B L E 7 Logistic-regression analysis for previous uptake of cervical cancer screening (n = 213) about AIDS disclosure'.…”

A Socio-Ecological Framework for Cancer Prevention in Low and Middle-Income Countries

“…Effective screening efforts are associated with earlier stages at diagnosis, and detection of cancers that are more amenable to curative treatment, leading to better outcomes (67). There are several barriers to the secondary prevention of cancer in LMICs including limited infrastructure, few trained personnel, high cost of equipment purchase and maintenance, and inadequate training of healthcare providers (68,69). In areas where screening programs exist, some LMICs experience a simultaneous over-and under-utilization of these services; screening resources and personnel are often clustered in urban settings, where there is a large population base and high demand, limiting opportunities for screening in rural settings.…”