Knowledge, Attitudes, and Practices Regarding Cervical Cancer Screening among HIV-infected Women at Srinagarind Hospital: A Cross-Sectional Study

Abstract

Introduction: In recent years, the lives of HIV-infected patients in Thailand have improved significantly due to continuous advances in treatment. However, the rate of cancer related to HIV infection (especially cervical cancer) is likely to increase. Although the World Health Organization (WHO) recommends Papanicolaou testing in all HIV-infected women, few of these patients receive this kind of screening in Thailand. Therefore, we conducted this study to evaluate the knowledge, attitudes, and practices of these patients with regard to cervical cancer screening. Materials and Methods: This cross-sectional study was conducted in HIV-infected women aged 18-65 years from April to November 2019 via a self-administered cervical cancer screening questionnaire, which consisted of four parts: demographic data, knowledge, attitudes, and practices. Results: Three hundred HIV-infected women were recruited. Most of the participants had good attitudes toward screening and practiced adequate screening (75.3% and 71.3%, respectively). However, only 62 participants (20.7%) demonstrated adequate knowledge. The crucial factors that were associated with adequate screening practice were age 40-49 years-old (AOR =3.26, 95%CI=1.02-10.37), CD4 cell count (AOR = 3.41, 95%CI = 1.29-8.99), having been advised about cervical cancer screening (AOR= 6.23, 95%CI 1.84-21.07), and attitude toward screening (AOR= 5.7, 95%CI = 2.23-14.55). The major reasons for not undergoing screening were embarrassment (41.86%), lack of symptoms (41.86%), fear of the results (36.04%), and fear of pain (36.04%). Conclusion: The reasons for inadequate testing were disregard and misconceptions about the procedure. To prevent invasive cervical lesions in HIV-infected women, health care providers should inform these patients about the importance of regular cervical cancer screening.

Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review

“…A majority of the studies ( n = 17) were published between 2011 to 2020. The prevalence of ever having pap smear screening ranged between 36.6% to 89.8% [ 48 , 49 , 50 , 51 , 53 , 57 , 59 , 64 , 66 , 69 , 70 ], while screening with pap smear or VIA in the past five years ranged from 32.5% to 85.8% [ 52 , 54 , 58 , 61 , 62 ]. Most of the studies described pap smears as the screening modality while one study explored the willingness to screen with a self-HPV test [ 67 ].…”

“…A majority of the 19 studies reporting barriers in Thailand described barriers classified under psychological or emotional factors ( n = 15) and risk perception ( n = 13). Similar to Malaysia, embarrassment was the most common reason for not receiving CCS in Thailand [ 48 , 49 , 50 , 51 , 53 , 57 , 58 , 59 , 60 , 62 , 69 , 70 ]. This is followed by poor knowledge of screening [ 48 , 50 , 51 , 53 , 61 , 62 , 63 , 67 , 68 , 70 ], having no symptoms [ 48 , 49 , 50 , 53 , 54 , 58 , 59 , 61 , 62 , 68 , 69 ], busyness or the lack of time [ 50 , 53 , 54 , 57 , 58 , 59 , 62 , 63 , 70 ], fear of pain [ 48 , 49 , 50 , 53 , 58 , 63 , 69 , 70 ], and poor per...…”

“…This is followed by poor knowledge of screening [ 48 , 50 , 51 , 53 , 61 , 62 , 63 , 67 , 68 , 70 ], having no symptoms [ 48 , 49 , 50 , 53 , 54 , 58 , 59 , 61 , 62 , 68 , 69 ], busyness or the lack of time [ 50 , 53 , 54 , 57 , 58 , 59 , 62 , 63 , 70 ], fear of pain [ 48 , 49 , 50 , 53 , 58 , 63 , 69 , 70 ], and poor perceived susceptibility [ 48 , 50 , 51 , 54 , 58 , 62 , 69 , 70 ]. Besides that, religion [ 48 , 53 , 62 , 70 ], and having a poor impression of the health system [ 56 , 58 , 60 ...…”

“…Of the 17 studies reporting facilitators, nine described facilitators in the health system category, while eight reported demographic-related facilitators. The top facilitator of CCS was receiving advice from healthcare workers [ 48 , 53 , 54 , 56 , 61 , 69 ]. This is followed by demographic and socio-economic factors such as age [ 50 , 64 , 65 , 69 , 70 ], income level [ 54 , 56 , 68 , 70 ], and education status [ 53 , 62 , 64 , 70 ].…”

“…Of the 17 studies reporting facilitators, nine described facilitators in the health system category, while eight reported demographic-related facilitators. The top facilitator of CCS was receiving advice from healthcare workers [48,53,54,56,61,69] This is followed by demographic and socio-economic factors such as age [50,64,65,69,70], income level [54,56,68,70], and education status [53,62,64,70]. Having gynecological symptoms were amongst the top facilitators and was also more commonly reported in Thailand compared to other countries [50,53,54,66,68].…”