Factors associated with underutilization of cervical cancer screening services among HIV positive women in Serenje District, Central Province

Cervical cancer is the most common cancer among women living with Human Immunodeficiency Virus (HIV) (UNAIDS, 201959). An estimated 604,000 new cases were diagnosed globally, with 342,000 deaths recorded in 2020 (Sung et al., 202169). According to WHO (2020), approximately 6.5% of all female cancers are cervical cancer-related, with 5% of cases attributable to HIV. Zambia ranks second in cervical cancer incidence, with an estimated mortality of 1,839 (WHO, 202056). The current utilization of cervical cancer screening services (CCSS) in Zambia among HIV-positive women stands at 27%, indicating underutilization (UNAIDS, 201959). In Serenje District, only 25.8% of HIV-positive women access these services. This study determined factors associated with the underutilization of CCSS among HIV-positive women in Serenje District.

A descriptive cross-sectional study was conducted involving 303 HIV-positive women in Serenje District of Central Province, Zambia. Systematic random sampling was used to recruit respondents from selected facilities, and a structured questionnaire was employed for data collection. Statistical Software (STATA V15) was utilized for analysis. Univariate, bivariate, and multivariable logistic regressions were performed to determine associations between variables.

Utilization of CCSS in Serenje District was low, with only 42.24% of respondents reporting service use. Being far from a healthcare facility [AOR: 0.49 (P<0.036, 95% CI 0.25-0.96)], low/inadequate knowledge [AOR: 0.26 (P<0.001, 95% CI 0.13-0.54)], low income [AOR: 0.16 (P<0.001, 95% CI 0.06-0.37)], and negative attitudes towards CCSS [AOR: 0.26 (P<0.001, 95% CI 0.12-0.53)] were significant contributors to reduced utilization.

Low knowledge, poor attitudes, far distances to healthcare facilities, and poor socioeconomic status were identified as key factors contributing to the underutilization of CCSS. It is recommended that the district designs and implements awareness campaigns on cervical cancer screening services, engages in outreach awareness campaigns, and conducts screening camps to bring these services closer to the communities. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance was obtained from the University of Zambia, Research Ethical Committee (UNZABREC) and authority from the national health research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All relevant data are within the manuscript. ABBREVIATIONS - CC - Cervical Cancer - CCS - Cervical Cancer Screening - CCSS - Cervical Cancer Screening Services - CDC - Centre of Disease Control and prevention - HPV - Human Papillomavirus - ICC - Invasive Cervical Cancer - MoH - Ministry of Health - VIA - Visual Inspection with Acetate - WHO - World Health Organization - HIV - Human Immunodeficiency Virus - UNAIDS - Joint United Nations programme on HIV/AIDS - LMIC - Low Middle-Income Countries