Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality

Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality View ORCID Profile Dickson Doto , Laura Shirima , View ORCID Profile Blandina Mmbaga , View ORCID Profile Deogratius Kinoko , Innocent Mboya , Innocent H. Peter Ughh , Alex Mremi , Patricia Swai , Bariki Mchome doi: https://doi.org/10.1101/2025.11.26.25341052 Dickson Doto 1 School of Public health, KCMC University , Moshi, Tanzania 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Dickson Doto For correspondence: dicksondoto1995{at}gmail.com Laura Shirima 1 School of Public health, KCMC University , Moshi, Tanzania MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Blandina Mmbaga 1 School of Public health, KCMC University , Moshi, Tanzania 2 Obstetrics and Gynecology Department, Kilimanjaro Christian Medical Centre (KCMC) , Moshi, Tanzania 3 Pathology Department, Kilimanjaro Christian Medical Centre (KCMC) , Moshi, Tanzania 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Blandina Mmbaga Deogratius Kinoko 1 School of Public health, KCMC University , Moshi, Tanzania MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Deogratius Kinoko Innocent Mboya 1 School of Public health, KCMC University , Moshi, Tanzania 5 Africa Academy of Public Health (AAPH) , Dar es salaam, Tanzania PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Innocent H. Peter Ughh 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alex Mremi 3 Pathology Department, Kilimanjaro Christian Medical Centre (KCMC) , Moshi, Tanzania 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Patricia Swai 2 Obstetrics and Gynecology Department, Kilimanjaro Christian Medical Centre (KCMC) , Moshi, Tanzania 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Bariki Mchome 2 Obstetrics and Gynecology Department, Kilimanjaro Christian Medical Centre (KCMC) , Moshi, Tanzania 4 Kilimanjaro Clinical Research Institute (KCRI) , Moshi, Tanzania PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Cervical cancer screening is a critical public health intervention that facilitate the early detection and treatment of cervical precancerous lesions before they progress to invasive cancer. The effectiveness of this intervention largely depends on timely and consistent adherence to recommended follow-up screenings. However, in Tanzania, the screening outcomes in follow-up screenings among WLHIV and its associated factors remain poorly understood. Objective To determine the screening outcomes in a follow-up screening and its associated factors among WLHIV who have undertaken their first screening between 2019 and 2022 in Moshi Municipality. Methodology This was a retrospective cohort study. Data were analyzed using STATA version 18.0. Descriptive statistics were employed to determine the screening outcomes in a follow-up screening. Multivariable logistic regression analysis was used to estimate adjusted odds ratios and 95% CI for the factors associated with the screening outcomes. Results Among 1,019 WLHIV who adhered to a follow-up screening, only 43(4.2%) were diagnosed with abnormal screening outcome. Majority, 38(88.4%) of those diagnosed with abnormal screening outcomes were also previously diagnosed with such screening outcomes during their first screening and received treatment. Moreover, WLHIV with abnormal screening outcomes in their first screening were significantly more likely to have abnormal screening outcome again during their follow-up screening compared to those who initially screened normal [AOR=12.51, 95%Cl: 8.92 – 37.64]. Conclusion Abnormal screening outcomes in a follow-up screening was low. Improvements in the providing treatment for cervical precancerous lesions after the diagnosis in the first screening is essential to further minimize the proportion of abnormal screening outcomes in follow-up visit Introduction Cervical cancer screening is the crucial strategy in the fight against cervical cancer ( 1 ). It allows for the early detection and treatment of precancerous cervical lesions before they progress into invasive cervical cancer ( 2 ). Numerous studies have demonstrated that early cervical cancer screening combined with timely follow-up screenings can significantly reduce the burden of the disease ( 3 , 4 ). For instance, follow-up screening every 10 years can reduce the burden of cervical cancer by 40-60%, every 5 years by 85%, every 3 years by 91% and annually by 94% ( 5 ). Much of the global disease burden is borne in sub-Saharan Africa where approximately 85% of cervical cancer cases and 90% of related deaths occurs ( 6 ). The disease is also much more prevalent among WLHIV compared to the women in the general population ( 7 , 8 ). In response to this increased risk, WLHIV in Tanzania are eligible for their first cervical cancer screening as early as 25 years of age, compared to 30 years for women without HIV ( 9 ). Also, WLHIV are recommended to undertake a follow-up screening after a year compared to 3 years recommended for women with no HIV. Moreover, Visual Inspection with Acetic Acid (VIA) is currently the recommended cervical cancer screening method for WLHIV in the country. However, HPV DNA test is under pilot implementation and is expected to be incorporated soon as an optional screening method (10). Studies across the globe have indicates that women continue to present with abnormal screening outcomes in a follow-up screening despite having been treated for cervical precancerous lesions detected during their first screening ( 11 ). However, there is existence of disparity particularly between developed and underdeveloped countries. However, notable disparities exist between developed and developing countries ( 12 – 15 ). To our knowledge, no study in Tanzania has specifically examined this issue, Therefore, this study aimed to determine follow-up screening outcomes and their associated factors among WLHIV, using Moshi Municipality as the study area. Materials and Methods This was a retrospective cohort study, aiming to determine the screening outcomes in a follow-up screening and its associated factors among WLHIV who had undertaken their first screening between 2019 and 2022 in Moshi Municipality. For cervical cancer screening data, the study utilized data recorded in the National Health Management Information System (HMIS), which is locally known as Mfumo wa Taarifa za Uendeshaji wa Huduma za Afya (MTUHA). This system comprises both electronic and hardcopy registries. The electronic component contains aggregated summaries while the hardcopy registries contain detailed, individual-level screening records. The system is designed to ensures consistency and standardization in data collection and reporting, thereby providing a reliable source of information for monitoring and evaluating the cervical cancer screening programme in the country ( 16 ). Meanwhile for HIV related data, the study utilized CTC2 database, and the information of the study participants in that database were linked with their information in the cervical cancer screening registries, using their unique identification numbers. Moreover, four healthcare facilities were purposively selected out of six which offer cervical cancer screening services in the Municipality. This includes Mawenzi Regional Referral Hospital, St. Joseph Hospital, Majengo Health Centre and Chama cha Uzazi na Malezi Bora (UMATI). The study area was purposively selected because the Kilimanjaro region, which the Moshi Municipality is the part of, has consistently been ranked as the region with the highest prevalence of cervical cancer in the country ( 17 ). Additionally, the region is among the leading regions in the country in terms of the number of women screened for cervical cancer. So the selection of this study area ensured the inclusion of the most affected region by the disease in the country and guaranteed the availability of sufficient and reliable data to effectively address the study objectives ( 18 ). Descriptive statistics were used to summarize the socio-demographic and clinical characteristics of the study participants. The results for categorical variables were presented using frequencies and proportions, while results for continuous variables were summarized using means and standard deviations. Moreover, STATA 18.0 software was used for data cleaning and analysis. The difference in the screening outcomes in a follow-up screening by independent variables was assessed using the Chi-square test or Fisher’s exact test (when expected cell counts were less than 5). Moreover, multivariable logistic regression with robust standard errors was used to determine the odds ratios (OR) and their corresponding 95% confidence intervals (CI) for the factors associated with the screening outcomes in a follow-up screening. Moreover, prior to model fitting, key assumptions of logistic regression were thoroughly assessed. To assess for the presence of outliers in the continuous variables - age and parity, boxplot diagrams were used. When evidence for outliers was detected, the winsorization technique was applied to remove the outliers from those variables, and as a result, new variable without outliers were then generated, categorized into distinct groups based on the previous studies, and subsequently used in the model fitting ( 19 ). Also, to assess for the presence of multicollinearity among the independent variables, the spearman correlation technique was employed. In cases where multicollinearity was evident, one of the highly correlated variables was excluded. Moreover, alternative to logistic regression models were not used for this case because the prevalence for cervical cancer screening in the Municipality was above 10%, which is the cut-off point for opting for such models. Moreover, in the model building, crude odds ratio (COR) was first estimated for each independent variable. Variables found to be statistically significant at p-value <0.05, those with potential confounding effect and known clinical association with the screening outcomes in a follow-up screening were included in the multivariable logistic regression model. Additionally, potential interaction effects among the independent variables were also assessed during the multivariable analysis. However, evidence for such effect was not found. Also, both forward and backward stepwise logistic regression techniques were used in the multivariable analysis to identify the most parsimonious model and estimate adjusted odds ratio (AOR) for the predictors. Moreover, model selection was guided by the Akaike Information Criteria (AIC), whereby the model with the lowest AIC value was selected as the final model. Results A total of 3,076 participants were included in the study. Their mean age at the time of their first screening was 39.3 years, with the highest proportion, 1,121(36.4%), aged between 35 and 44 years. Most participants, 3,058(99.4%), were residing in Kilimanjaro region. Most participants, 2,557(83.1%), received their first screening at the healthcare facility rather than at an outreach facility. Additionally, the mean parity among the study participants was 2.7, with majority proportion, 2,213(71.9%), had between 2 and 4 parities at the time of the first screening. Also, majority, 2,771(90.1%), had no other reproductive comorbidities. Most, 973(31.6%), were classified as having WHO HIV stage I at the time of the first screening. Moreover, regarding HIV viral load, majority, 2,360(76.7%), had undetectable levels ( < 50 copies/mm 3 ) at the time of the first screening. Also, majority, 2,201(71.6%), had not yet developed Advanced HIV Disease (AHD) at the time of the first screening. Additionally, all of the screening procedures were performed by VIA method. Notably, all healthcare providers involved in the first screening, treatment of precancerous cervical lesions and follow-up screening were females ( Table 1 ) . View this table: View inline View popup Download powerpoint Table 1: Socio-demographic and clinical characteristics of the study participants (n=3,076) Bivariate and multivariate analysis Among 1,019 WLHIV who adhered to a follow-up screening, only 43(4.2%) [95%CI: 3.07% – 5.64%] were diagnosed with abnormal screening outcome whereas 976(95.8%) [95%CI: 94.3% – 96.9%] were diagnosed with normal screening outcome. All of the abnormal screening cases were categorized as small precancerous cervical lesions. Additionally, 38(88.4%) [95%CI: 74.9% – 96.1%] of those diagnosed with abnormal screening outcomes in a follow-up screening were also previously diagnosed with such screening outcomes in a first screening and received treatment for precancerous cervical lesions thereafter while the remaining 5(11.6%) [95%CI: 3.8% – 25.1%] were diagnosed with normal screening outcomes. 343(35.2%) of the participants who went to a referral healthcare facility for the first screening were diagnosed with normal screening outcomes in a follow-up screening. 329(3.3%) of the participants who were aged below 25 years at the time of the first screening were diagnosed with normal screening outcome in a follow-up screening. Also, 341(43.9%) of the participants who were at WHO HIV stage 1 at the time of the first screening were diagnosed with normal screening outcome in a follow-up screening. Also, 916(93.9%) of the participants diagnosed with normal screening outcome at the time of the first screening were again diagnosed with normal screening outcome in a follow-up screening. Additionally, 19(37.3%) of the participants who were treated with cryotherapy procedure after being diagnosed with precancerous cervical lesions at the time of the first screening were diagnosed with normal screening outcome. Moreover, 975(99.9%) of participants who were not suspected having invasive cervical cancer at the first screening, were diagnosed with normal screening outcome in a follow-up screening ( Table 2 ) . View this table: View inline View popup Table 2: Screening outcomes in a follow-up cervical cancer screening among the study participants by their socio-demographic and clinical characteristics (n=1,019). Moreover, in a multivariable analysis, after adjusting for the effect of other variables in the multivariable model, a statistically significant association was only found between the screening outcomes of the patients in a follow-up screening and their screening outcomes in their screening. Specifically, WLHIV who were diagnosed with abnormal screening outcomes in their first screening had 12.51 times higher odds of being yet again diagnosed with abnormal screening outcome in their follow-up screening compared to those who were diagnosed with normal screening outcomes in their first screening [AOR=12.51, 95%Cl: 8.92 – 37.64] ( Table 3 ) . View this table: View inline View popup Download powerpoint Table 3: Multivariable analysis of the factors associated with the screening outcomes in a follow-up cervical cancer screening among WLHIV who had undertaken the first screening between 2019 and 2022 in Moshi Municipality (n=1,019). Discussion The study revealed that 4.2% of WLHIV were diagnosed with abnormal screening outcome in the follow-up screening. A similar pattern was observed during their first screening whereby 4.0% of the screened WLHIV were diagnosed with abnormal screening outcome. These findings indicate a relatively low proportion of abnormal screening outcome among the participants in this study. This stands in sharp contrast to studies conducted in Kenya and Zimbabwe, which reported substantially higher proportions of abnormal screening outcome during a follow-up screening, 64.0% and 63.9%, respectively ( 8 , 15 ). Such disparities may be due to differences in population characteristics, screening programme implementation and/or diagnostic criteria across settings. Moreover, the study also revealed that 88.4% of WLHIV who were diagnosed with abnormal screening outcome in the follow-up screening were also diagnosed with such screening outcomes during their first screening, despite having received treatment for cervical precancerous lesions shortly after the first diagnosis. This finding suggests a notably low regression of precancerous cervical lesions following treatment, raising concerns about the effectiveness of the treatment methods currently used used and the potential need for improved clinical management and closer monitoring of such cases ( 22 ). On the other hand, this study found that 11.6% of participants who were diagnosed with abnormal screening outcome during the follow-up screening had initially received normal screening outcome during their first screening. This relatively high proportion may suggest the possibility of some of them having false-negative screening outcomes during their first screening. Such outcomes could have been attributed to the relatively low sensitivity and specificity of the screening modality used, inconsistencies in diagnostic interpretation, or variations in clinical judgement ( 23 ). These findings underscore the need to enhance the accuracy of cervical cancer screening through the use of more reliable diagnostic tools and standardized assessment criteria ( 24 ). In addition, the implementation of multiple testing approaches, either simultaneously or in parallel, could significantly increase the likelihood of correctly identifying the precancerous cervical lesions. Combining different screening methods such as VIA, HPV DNA test and pap smear test may offer improved diagnostic precision, particularly among high-risk WLHIV ( 25 ). Strength of the study The study incorporated a wide range of potential factors affecting the screening outcomes in a follow-up screening, including both socio-demographic and clinical variables in the study. This comprehensive inclusion allowed for a more robust analysis and better understanding of the key factors associated with the screening outcomes in a follow-up cervical cancer screening among WLHIV. Limitations of the study The registry from which data were obtained did not capture certain important demographic variables, such as educational attainment, marital status, employment status and ethnicity of the participants. This information could have provided a deeper understanding of even more social-demographic factors in influencing the screening outcomes in a follow-up cervical cancer screening Conclusion A small proportion of WLHIV were diagnosed with abnormal screening outcome in a follow-up screening, majority of them had also been diagnosed with such a screening outcome in their first screening, despite being treated thereafter. This suggests a limited regression of precancerous cervical lesions despite prior treatment for such abnormalities. Moreover, the only factor which was significantly associated with the screening outcomes in a follow-up cervical cancer screening was the screening outcomes in the first cervical cancer screening among the participants. Recommendations The Ministry of Health should consider adopting multiple testing methods, such as combining VIA, Pap smear, and HPV DNA testing as standard practice for cervical cancer screening among WLHIV. This approach would help to reduce false-negative results which will lead to improved diagnostic accuracy and ensure early detection of precancerous cervical lesions. Ethical approval Ethical approval for this study was obtained from the Ethical Review Committee of KCMC University, under clearance number PG 174/2024. In addition, permission to access data from the selected healthcare facilities in Moshi Municipality was granted by the respective authorities. Data Availability All data produced in the present study are available upon reasonable request to the authors Authorship contribution statement Dickson Doto: study conceptualization, design, data collection, analysis, report writing, and manuscript writing. Laura Shirima: data analysis, manuscript writing, review & editing, and supervision. Blandina Mmbaga: manuscript review & editing, mentorship and funding acquisition. Innocent Mboya: data analysis, manuscript review & editing, conceptualization and mentorship. Innocent H. Peter Ughh: manuscript writing, review & editing, Alex Mremi : manuscript writing, review & editing and mentorship. Deogratius Kinoko: manuscript writing, review & editing. Patricia Swai: data analysis, manuscript review & editing, conceptualization and supervision and Bariki Mchome: data analysis, manuscript review & editing, conceptualization and supervision. Funding The project on which this publication is based was in part funded by the German Federal Ministry of Education and Research 01KA2220B. This research was funded in part by Science for Africa Foundation to the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) program [Del-22-008] with support from Wellcome Trust and the UK Foreign, Commonwealth & Development Office and is part of the EDCPT2 programme supported by the European Union. Conflict of interest The authors declare no conflicts of interest regarding the publication of this paper Declaration of Artificial Intelligence (AI) assistance We acknowledge that AI tool (ChatGPT) was used solely to refine the clarity and readability of this work, without influencing its substantive ideas or content. All research activities – including data collection, analysis, results, and interpretation were entirely conducted by us and based exclusively on our original data. Download figure Open in new tab Figure 1: Cervical cancer screening outcome among the study participants during their first screening (n=3,076) Download figure Open in new tab Figure 2: Categories of abnormal screening outcomes during the first screening (n=3,076) Download figure Open in new tab Figure 3: Cervical cancer screening outcomes in the follow-up screening (n=1,019) Acknowledgements We give our sincere gratitude to the Kilimanjaro Clinical Research Institute (KCRI) under the Network for Oncology Research in Africa (NORA ) project for their financial support towards this work. We also thank the administration of the Moshi Municipality and the selected healthcare facilities for their invaluable cooperation during the data acquisition process. References 1. ↵ World Health Organization . Comprehensive cervical cancer control: a guide to essential practice [Internet]. 2nd ed. Geneva : World Health Organization ; 2014 [cited 2024 Dec 27]. 364 p. Available from: https://iris.who.int/handle/10665/144785 2. ↵ Sedani A , Soliman AS , Msami K , Msemo D , Mwaiselage J , Schmid K , et al. Impact of Initiating Screening Programs on Referral and Management of Cervical Cancer in Tanzania . JGO . 2019 Dec ;( 5 ):JGO.18.00052. 3. ↵ Paolino M , Gago J , Pera AL , Cinto O , Thouyaret L , Arrossi S. Adherence to triage among women with HPV-positive self-collection: a study in a middle-low income population in Argentina . Ecancermedicalscience . 2020 ; 14 : 1138 . OpenUrl PubMed 4. ↵ Sedani A , Soliman AS , Msami K , Msemo D , Mwaiselage J , Schmid K , et al. Impact of Initiating Screening Programs on Referral and Management of Cervical Cancer in Tanzania . JGO [Internet] . 2019 Dec [cited 2025 July 22];( 5 ). Available from: https://ascopubs.org/doi/10.1200/JGO.18.00052 5. ↵ Brisson M , Kim JJ , Canfell K , Drolet M , Gingras G , Burger EA , et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries . Lancet . 2020 Feb 22; 395 ( 10224 ): 575 – 90 . OpenUrl CrossRef PubMed 6. ↵ Hull R , Mbele M , Makhafola T , Hicks C , Wang SM , Reis RM , et al. Cervical cancer in low and middle-income countries . Oncol Lett . 2020 Sept ; 20 ( 3 ): 2058 – 74 . OpenUrl CrossRef PubMed 7. ↵ Henke A , Kluge U , Borde T , Mchome B , Serventi F , Henke O. Tanzanian women’s knowledge about Cervical Cancer and HPV and their prevalence of positive VIA cervical screening results . Data from a Prevention and Awareness Campaign in Northern Tanzania, 2017 – 2019. Global Health Action [Internet] . 2021 Jan 1 [cited 2025 July 22]; 14 ( 1 ). Available from: https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1852780 8. ↵ Shrestha S Taghavi K , Mandiriri A , Shamu T , Rohner E , Bütikofer L , Asangbeh S , et al. Cervical Cancer Screening Cascade for women living with HIV: A cohort study from Zimbabwe . Shrestha S , editor. PLOS Glob Public Health . 2022 Feb 2; 2 ( 2 ): e0000156 . OpenUrl 9. ↵ Sung H , Ferlay J , Siegel RL , Laversanne M , Soerjomataram I , Jemal A , et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries . CA A Cancer J Clinicians . 2021 May ; 71 ( 3 ): 209 – 49 . OpenUrl CrossRef 11. ↵ Sung H , Ferlay J , Siegel RL , Laversanne M , Soerjomataram I , Jemal A , et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries . CA A Cancer J Clinicians . 2021 May ; 71 ( 3 ): 209 – 49 . OpenUrl CrossRef 12. ↵ Joshi S , Muwonge R , Kulkarni V , Mandolkar M , Lucas E , Pujari S , et al. Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India . Intl Journal of Cancer . 2023 Jan 15; 152 ( 2 ): 249 – 58 . OpenUrl 13. Jørgensen SF , Andersen B , Petersen LK , Rebolj M , Njor SH . Adherence to follow□up after the exit cervical cancer screening test at age 60–64: A nationwide register□based study . Cancer Medicine . 2022 Jan ; 11 ( 1 ): 224 – 37 . OpenUrl PubMed 14. Stroetmann CY , Gizaw M , Alemayehu R , Wondimagegnehu A , Rabe F , Santos P , et al. Adherence to Treatment and Follow-Up of Precancerous Cervical Lesions in Ethiopia . The Oncologist . 2024 May 3; 29 ( 5 ): e655 – 64 . OpenUrl PubMed 15. ↵ Omenge Orang’o E , Liu T , Christoffersen-Deb A , Itsura P , Oguda J , Washington S , et al. Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities . AIDS . 2017 Jan 14; 31 ( 2 ): 233 – 40 . OpenUrl PubMed 16. ↵ Wilms MC , Mbembela O , Prytherch H , Hellmold P , Kuelker R. An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania . BMC Health Serv Res [Internet] . 2014 Dec [cited 2025 July 12]; 14 ( 1 ). Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-91. 17. ↵ 68f8a6459b41a948572500 . 18. ↵ Mahiti GR , Adam J , Luoga P. Prevalence and determinants of cervical cancer screening among women aged 15–49 years in Tanzania: analysis of demographic and health survey 2022 . Arch Public Health [Internet] . 2025 May 23 [cited 2025 July 13]; 83 ( 1 ). Available from: https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-025-01629-w 19. ↵ Adams J , Hayunga D , Mansi S , Reeb D , Verardi V. Identifying and treating outliers in finance . Financial Management . 2019 June ; 48 ( 2 ): 345 – 84 . OpenUrl 20. Omenge Orang’o E , Liu T , Christoffersen-Deb A , Itsura P , Oguda J , Washington S , et al. Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities . AIDS . 2017 Jan 14; 31 ( 2 ): 233 – 40 . OpenUrl PubMed 21. Taghavi K , Mandiriri A , Shamu T , Rohner E , Bütikofer L , Asangbeh S , et al. Cervical Cancer Screening Cascade for women living with HIV: a cohort study from Zimbabwe . PLOS Glob Public Health . 2022 ; 2 ( 2 ): e0000156 . OpenUrl 22. ↵ Aerssens A , Claeys P , Garcia A , Sturtewagen Y , Velasquez R , Vanden Broeck D , et al. Natural history and clearance of HPV after treatment of precancerous cervical lesions . Histopathology . 2008 Feb ; 52 ( 3 ): 381 – 6 . OpenUrl CrossRef PubMed 23. ↵ Parashari A , Singh V. Reasons for Variation in Sensitivity and Specificity of Visual Inspection with Acetic Acid (VIA) for the Detection of Pre-Cancer and Cancer Lesions of Uterine Cervix . Asian Pacific Journal of Cancer Prevention . 2013 Dec 31; 14 ( 12 ): 7761 – 2 . OpenUrl PubMed 24. ↵ Denton KJ , Bergeron C , Klement P , Trunk MJ , Keller T , Ridder R. The Sensitivity and Specificity of p16INK4a Cytology vs HPV Testing for Detecting High-Grade Cervical Disease in the Triage of ASC-US and LSIL Pap Cytology Results . American Journal of Clinical Pathology . 2010 July 1; 134 ( 1 ): 12 – 21 . OpenUrl CrossRef PubMed 25. ↵ Yazdani S , Asli A , Asli A , Sarbakhsh P , Salemi S. Final Sensitivity and Specificity of Different Test Combinations in Screening . JMED . 2014 Apr 23;1–10. View the discussion thread. Back to top Previous Next Posted November 27, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality Dickson Doto , Laura Shirima , Blandina Mmbaga , Deogratius Kinoko , Innocent Mboya , Innocent H. Peter Ughh , Alex Mremi , Patricia Swai , Bariki Mchome medRxiv 2025.11.26.25341052; doi: https://doi.org/10.1101/2025.11.26.25341052 Share This Article: Copy Citation Tools Screening Outcomes and Associated Factors in a Follow-up Cervical Cancer Screening among Women Living with HIV, 2019–2024: Evidence from Moshi Municipality Dickson Doto , Laura Shirima , Blandina Mmbaga , Deogratius Kinoko , Innocent Mboya , Innocent H. Peter Ughh , Alex Mremi , Patricia Swai , Bariki Mchome medRxiv 2025.11.26.25341052; doi: https://doi.org/10.1101/2025.11.26.25341052 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Epidemiology Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (299) Cardiovascular Medicine (4425) Dentistry and Oral Medicine (443) Dermatology (382) Emergency Medicine (607) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1507) Epidemiology (15221) Forensic Medicine (30) Gastroenterology (1123) Genetic and Genomic Medicine (6588) Geriatric Medicine (667) Health Economics (997) Health Informatics (4524) Health Policy (1368) Health Systems and Quality Improvement (1612) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15910) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (145) Nephrology (667) Neurology (6588) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1143) Occupational and Environmental Health (956) Oncology (3331) Ophthalmology (970) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (663) Pediatrics (1690) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5440) Public and Global Health (9220) Radiology and Imaging (2195) Rehabilitation Medicine and Physical Therapy (1369) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (710) Sports Medicine (529) Surgery (710) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ffd11bb6bfcad07',t:'MTc3OTQ2NTk5OA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();