Factors Associated with Uptake of Visual Inspection with Acetic Acid (VIA) for Cervical Cancer Screening in Western Kenya

Abstract

PurposeCervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya.Participants and MethodsUsing items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18–55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya between April 2014 and September 2014. We used logistic regression modeling to assess factors associated with uptake (or non-uptake), associated odds ratios (ORs) and the 95% confidence intervals (95% CI).ResultsOnly two hundred and seventy-three women out of 2505 (11%) accepted VIA cervical cancer screening. Knowledge of just how women are screened for cervical cancer was significantly associated with reduced uptake of cervical cancer screening (OR: 0.53; CI 0.38–0.73) as was fear that screening would reveal a cancer (OR 0.70; CI 0.63–0.77), and reliance on prayer with the onset of illness (OR 0.43; CI 0.26–0.71). Participants who thought that one should get cervical cancer screening even if there were no symptoms were more than twice as likely to accept cervical cancer screening (OR 2.21; 95% CI 1.24–3.93). Older patients, patients living with HIV and women who do not know if bleeding immediately after sex might be a sign of cervical cancer were also more likely to accept screening (OR 1.03, CI 1.02–1.04; OR 1.78, CI 1.01–3.14; OR 2.39, CI 1.31–4.39, respectively).ConclusionsIn our population, a high percent of women knew that it is appropriate for all women to get cervical cancer screening, but only a small proportion of women actually got screening. There may be an opportunity to design educational materials for this population that will not only encourage participation in cervical cancer screening but also remediate misconceptions. The discussion illustrates how our findings could be used in such an effort.

Screening for human papillomavirus, cervical cytological abnormalities and associated risk factors in HIV‐positive and HIV‐negative women in Rwanda

“…Among both HIV‐positive and HIV‐negative women, a high proportion of women were not aware of the test. About two‐third of the cohorts were not aware of the cervical cancer screening test, which is lower than in countries such as Kenya and Uganda . A large proportion of HIV‐positive women reported economical reasons for not undergoing cervical cancer screening, which is commonly reported in developing countries .…”

The impact of scaling up cervical cancer screening and treatment services among women living with HIV in Kenya: a modelling study

“…The sensitivity and specificity of screening tests and the efficacy of treatment options replicated reported parameters from recent Kenyan studies among WHIV in care (table 1). Also, rates of individuals refusing CC screening services and LTFU reflect those observed in programmatic evaluations within HIV care facilities in Kenya 9 10 20–23. Individuals for whom treatment was effective and who recovered were assumed to remain cervical disease free for 24 months and, as above, go back to susceptible thereafter and be at risk of new HPV infections accounting for their age and ART status.…”

“…However, a recent national survey indicated that only 16.4% of eligible women, regardless of HIV status, had ever been screened for CC 8. Practical challenges to achieving screening targets include overall low acceptability of CC screening, high loss to follow-up (LTFU) rates, and infrastructure and commodity constraints 9 10…”

Development of a comprehensive and sustainable gynecologic oncology training program in western Kenya, a low resource setting

“…This required both to commit resources for cervical cancer screening. Over the last 6 years VIA screening has expanded to include more than 60,000 women (Orang'o et al, 2016a) (Fig. 1).…”