Acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women: a mixed methods study at Mbarara regional referral hospital

Abstract

Background: Integrating Cervical Cancer Screening (CCS) into routine HIV care has been endorsed as an effective strategy for increasing uptake of CCS, and facilitating early detection and treatment of pre-cancerous lesions among HIV-infected women in Sub Saharan Africa. In Uganda, this strategy has not been implemented yet in most HIV clinics. Assessing the acceptability of this intervention among HIV-infected women is of great relevance to inform its implementation. Objective: To assess the acceptability of integration of Cervical Cancer Screening (CCS) into routine HIV care, associated factors and perceptions among HIV-infected women enrolled in the Immune Suppression Syndrome clinic at Mbarara Regional Referral Hospital (MRRH). Methodology: A mixed methods study utilizing the explanatory sequential approach was conducted among 327 eligible HIV-infected women. Acceptability of integration of CCS into routine HIV care was measured using the Theoretical Framework of acceptability (TFA). A pre-tested questionnaire was used to collect quantitative data. Focus group discussions to explore perceptions regarding the intervention were conducted among purposively selected HIV-infected women. Descriptive analyses for all categorical dependent and independent variables were done. Modified poisson regression with robust variance analysis was utilized to determine factors associated with the acceptability of the intervention. Statistical significance was determined at p-value <0.05. The analysis was performed using STATA Version 14.0. Thematic analysis utilizing inductive coding was used to analyze qualitative data in Atlas.ti 6.0. Results: Majority of the HIV-infected women (64.5%) accepted the integration of CCS into routine HIV care. Religion, perceived risk of developing CC and ever screened for CC were statistically significantly associated with the acceptability of integration of CCS into routine HIV care. Perceived benefits of the proposed intervention were: convenience to seek for CCS, motivation to undergo CCS, improved archiving of CCS results, the confidentiality of HIV patient information, and preference to interact with ISS clinic health workers. Shame to expose their privacy to the ISS clinic health workers and increased waiting time were the only perceived challenges of the integration of CCS into routine HIV care. Conclusion: Study findings highlight the need to take advantage of this acceptability to prioritize implementation of the integration of CCS into routine HIV care, conduct intensified health education and awareness about the increased risk of developing CC among HIV-infected women. HIV-infected women should be reassured of confidentiality and reduced waiting time to increase the uptake of the integrated CCS and HIV services among HIV-infected women along the continuum of HIV care and treatment services.