Integrating cervical cancer screening with HIV care in a district hospital in Abuja, Nigeria

Abstract

Background:Human immunodeficiency virus positive (HIV+) women have a higher risk of developing invasive cervical cancer compared with uninfected women. This study aims to document programmatic experience of integrating cervical cancer screening using Visual Inspection and Acetic Acid (VIA) into HIV care as well as to describe patients’ characteristics associated with positive VIA findings amongst HIV+ women.Materials and Methods:A cross-sectional study analysed routine service data collected at the antiretroviral therapy (ART) and cervical cancer screening services. Our program integrated screening for cervical cancer using VIA technique to HIV care and treatment services through a combination of stakeholder engagement, capacity building for health workers, creating a bi-directional referral between HIV and reproductive health (RH) services and provider initiated counselling and screening for cervical cancer. Information on patients’ baseline and clinical characteristics were captured using an electronic medical records system and then exported to Statistical Package for the Social Sciences (SPSS). Logistic regression model was used to estimate factors that influence VIA results.Results:A total of 834 HIV+ women were offered VIA screening between April 2010 and April 2011, and 805 (96.5%) accepted it. Complete data was available for 802 (96.2%) women. The mean age at screening and first sexual contact were 32.0 (SD 6.6) and 18.8 (SD 3.5) years, respectively. VIA was positive in 52 (6.5%) women while 199 (24.8%) had a sexually transmitted infection (STI). Of the 199 who had a STI, eight (4.0%) had genital ulcer syndrome, 30 (15.1%) had lower abdominal pain syndrome and 161 (80.9%) had vaginal discharge syndrome. Presence of lower abdominal pain syndrome was found to be a significant predictor of a positive VIA result (P = 0.001). Women with lower abdominal pain syndrome appeared to be more likely (OR 47.9, 95% CI: 4.8-480.4, P = 0.001) to have a positive VIA result.Conclusion:The high burden of both HIV and cervical cancer in developing countries makes it a necessity for integrating services that offer early detection and treatment for both diseases. The findings from our study suggest that integrating VIA screening into the package of care offered to HIV+ women is feasible and acceptable.

Integrating cervical cancer with HIV healthcare services: A systematic review

“…Resources described include: material to provide education and support to patients [5, 28, 34, 40]; staff to operate the referral system [28, 30]; staff to coordinate integration[28]; forms or electronic medical records [4, 36]; and medical and adequate infrastructure, including consistent electricity and water supply.…”

Integrating cervical cancer screening and preventive treatment with family planning and HIV‐related services

“…Cervical cancer services were integrated into HIV/AIDS programming in six African countries: Ethiopia, Kenya, Malawi, Tanzania, Zambia, Zimbabwe (program data, unpublished). In Zambia, Malawi, and Botswana, screening and cryotherapy services were integrated into existing national HIV/AIDS care and treatment programs, resulting in increased coverage of screening and treatment services for HIV‐positive women .…”

“…25 Forwomenwhorequirehigher-levelcare(suchasbiopsy,surgery, or radiotherapy) the dearth of trained providers, lack of equipment, highcostofservices,andlackofastandardizedreferralsystemhave asignificantimpactonmorbidityandmortalityofwomen.InNigeria, nearly 70% of VIA-positive women were unable to access treatment services at tertiary facilities owing to high financial costs of treatment. 20 Often treatment for invasive cervical carcinoma is only availableatasingletertiaryfacility,locatedinthecapital. 19 Theavailability of higher-level services is even more critical for HIV-positive women,astheyaremorelikelytohaveextensivelesionsthatdonot meetthecriteriafortreatmentwithcryotherapy.…”

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

“…Duber et al found that vertical programs, even on the scale of PEPFAR, may not impact health outcomes that were not specifically targeted on a national level [12]. Attempts have been made to integrate donor-funded HIV prevention, care, and treatment programs into national health systems to ensure efficiency and sustainability, including: TB [13••, 14], maternal-child health (MCH) [15–20], cervical cancer screening [21], sexually transmitted infection (STI) [16, 22], and family planning [23, 24] programs. In addition, ART has increased the life expectancy of people living with HIV, and HIV is now considered a chronic disease.…”