Assessing the implementation fidelity of self-collect HPV cervical cancer screening among HIV positive women in Wakiso District, Uganda; a survey of public healthcare facilities.

Abstract

Cervical cancer is the fourth most common cancer affecting women worldwide with an estimated 640,000 new cases in 2020 and an estimated 342,000 deaths. In Uganda, cervical cancer remains the most common cause of cancer mortality and morbidity despite the available cervical cancer prevention strategies put in place. This study aimed to assess the fidelity of implementation of self-collect HPV cervical cancer screening among HIV-positive women and associated barriers and facilitators in selected public healthcare facilities in Wakiso District, Uganda. Methodology: This was a mixed-methods study design involving qualitative and quantitative methods. Quantitative data was collected by review of documents of 2467 HIV-positive women who had undergone cervical cancer screening from two high-volume public health center IIIs and 6 health center IVs in Wakiso district from 1/1/2023 to 31/12/2023. Qualitative data was collected using key informant interviews with health workers and health administrators and in-depth interviews with a few selected patients. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed using thematic content analysis. Results: Data from 2467 HIV-positive women was retrieved. The average age was 32.95 (±7.11). Most women (72.9%) had their HPV samples collected by health providers, while only 27.1% did self-collection. Most participants received their results, slightly higher in provider-collected (98.4%) than self-collected (97.0%). HPV-positive results were present in 13.3% of the mothers screened. The implementation fidelity for self-collect was good, with 97.0% (of mothers who did HPV self-collect) receiving results and 92.5% of positive mothers receiving treatment. This was facilitated by effective health education messages about HPV, perceived privacy and convenience of the approach. However, barriers such as poor delivery of health education, lack of guidelines and IEC materials, patient fears of collection tools, and logistical challenges like stockouts and work overload hinder effective implementation. Conclusion: Participants in this study demonstrated a preference for clinician-collected HPV samples over self-collected HPV samples. Despite a low uptake, the implementation fidelity for HPV self-collect in Wakiso was good as 9 in 10 mothers who did HPV self-collect were able to receive their results and 9 out of 10 HPV-positive mothers received treatment. There is a need to address patients' and healthcare workers’ fears related to HPV self-collection to make it embraced by all HIV-positive mothers as a desired sample collection method.