Knowledge, practices, and perceptions of the healthcare providers on cervical cancer screening among HIV-positive women at Lira Regional Referral Hospital, Lira City.

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Florence Layet, Tom Murungi, Nasser Ashaba, Mirembe Renniter Nakayita, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5000041/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical cancer remains a global burden and is by far one of the major causes of premature death among women of reproductive age. We explored the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women aged 18-49 years in Lira City. Methods: In June 2023, a qualitative cross-sectional study was conducted among healthcare providers at Lira Regional Referral Hospital (LRRH), Lira City, Northern Uganda. Key informant interviews (KII’s) were used to collect data among purposively selected healthcare providers. Interviews were audio-recorded, transcribed verbatim and coded using the NVivo (QSR International) software. Thematic content analysis was used in data analysis. Results: The study found that participants had good knowledge about cervical cancer and screening. They provided health education, and vaccination for eligible girls and screened HIV-positive women for cervical cancer. Long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers were reported as barriers to CCS utilization. However, increased awareness, the presence of signs/symptoms, and the desire to maintain optimal health facilitated CCS utilisation among HIV-positive women. Conclusion: Healthcare providers knew about cervical cancer screening by HPV testing and Visual Inspection with Acetic acid and provided routine health education on screening, and cervical cancer screening to HIV-positive women. They perceived increased demand for CCS services by HIV-positive women, which is attributed to their increased awareness, the presence of signs and symptoms, and their desire to maintain optimal health. Despite several hindering factors, such as long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers, the practice of cervical cancer screening can be improved by reducing waiting times, increasing access to healthcare facilities, and ensuring that patients feel comfortable throughout the screening process. Obstetrics & Gynecology Knowledge Practices Perceptions Healthcare providers Cervical Cancer Screening Introduction Cervical cancer remains a global burden and is by far one of the major causes of premature death among women in the reproductive age( 1 , 2 ). Low- and middle-income countries bear the highest burden of cervical cancer incidences and deaths among women( 2 ). Sub-Saharan Africa, specifically Eastern and Southern Africa contributes the highest cervical cancer deaths and incidences as well as the highest burden of high-risk Human papillomavirus( 1 , 3 , 4 ). Infection with the Human Papillomavirus is responsible for the majority of cervical cancers with HPV types 16 and 18 causing about 70% of cervical cancers( 5 ). However, women infected with HIV are at higher risk of developing cancer of the cervix ( 6 ) and the disease is frequent among those aged 18–49 years( 7 ). Annually, about 6,959 new cervical cancer cases are diagnosed with about 4,607 cervical cancer deaths among women in Uganda( 8 ). Nearly all cervical cancers can be prevented through HPV vaccination of all eligible girls, HPV testing, routine cervical cancer screening as well as early initiation of treatment for precancerous lesions( 9 , 10 ). To reduce cervical cancer incidences and deaths, the World Health Organization (WHO) recommends regular cervical cancer screening for 70% of women and treatment for 90% of those with pre-cancer lesions( 11 ). Furthermore, frequent cervical cancer screening among women living with HIV from 25 years of age is recommended( 5 ). Uganda recommends annual cervical cancer screening for women living with HIV( 12 , 13 ). Unfortunately, screening among women living with HIV is still low and affected by both systematic, structural, and contextual factors( 14 , 15 ). Healthcare providers, especially nurses, gynaecologists, medical officers and midwives in Uganda are the primary providers of cervical cancer screening services( 12 ). They have more opportunities to counsel HIV-positive women on CCS because they spend more quality time with them( 12 , 16 ). They are crucial in preventing cervical cancer by knowing screening guidelines, risk factors, screening technologies, interpretation of results, follow-up strategies, and patient counselling( 16 ). Thus, it is of utmost importance that healthcare providers have better practices and adequate knowledge towards cervical cancer screening. Their expertise is vital in detecting cervical abnormalities early and managing them effectively, which ultimately reduces the incidence of, and mortality associated with this disease. Literature suggests that the knowledge of healthcare providers on cervical cancer screening is suboptimal ( 18 – 20 ), which sabotages the global targets for cervical cancer mitigation. However, evidence from some studies shows that healthcare providers are knowledgeable and are significantly contributing to cervical cancer screening( 21 – 24 ). Cervical cancer prevention measures in Lira district such as HPV vaccination for young girls and cervical cancer screening have markedly been suboptimal( 25 – 27 ) despite the existing provider-led interventions( 13 ). Notably, data are plausible regarding the perceptions of health providers towards CCS among HIV-positive women. Moreover, it is recommended that the perspectives of the healthcare providers be explored qualitatively according to a previous study in Uganda( 28 ). This study provides valuable insights into the issue and underlines the need for action to improve cervical cancer prevention and management in Lira City and similar settings. It is against this background that our study explored the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women in Lira City. Materials and Methods Study Design and Setting This was a cross-sectional qualitative study that used thematic analysis to identify the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women in Lira City. Key informant interviews (KII’s) were used to collect data among healthcare care providers at Lira Regional Referral Hospital who were purposively selected based on (I) the Department/unit where they worked and (II) Cadre. The study used an explanatory model to investigate why HIV-positive women don’t use CCS services and understand the knowledge and practices of healthcare providers on CCS among HIV-positive women. The study was conducted among healthcare providers at Lira Regional Referral Hospital (LRRH), Lira City, Northern Uganda in June 2023. Routine cervical cancer screening services at LRRH are provided at the cervical cancer unit at a free cost and the clinic has 5 working days a week. HIV-positive women requiring CCS services from the ART clinic, family planning unit, and Early Infant Diagnosis (EID) clinic at LRRH are sent to the cervical cancer screening unit. Screening is conducted majorly by nurses and midwives and rarely by a medical officer. Other cervical screening opportunities in Lira City are one by way of outreaches which are either part of the hospital program or supported by non-government organizations. Study participants The study participants comprised Healthcare providers who offer care to HIV-positive women at LRRH, Lira City. In this study, healthcare providers with experience in cervical cancer prevention and control, and those who provide care to HIV-positive women at their clinics were included for key informant interviews. Specifically, nurses, midwives, and medical officers who are at the forefront of the implementation of cervical cancer screening were included in the study. Participants were most likely to have been working in antenatal, EID, family planning, and cervical cancer screening clinics. We did not recruit healthcare providers who don’t interact with HIV-positive clients for a long time such as laboratory technicians and sonographers. Sample size and sampling procedure We purposely selected LRRH because it is a regional referral hospital with the capacity to conduct cervical cancer screening and by the fact that they serve a large number of HIV-positive clients at their clinics. Within the hospital, we purposively selected four units/clinics, i.e., antenatal, EID, family planning, and cervical cancer screening clinics because they had healthcare providers with practical experience in cervical cancer screening as well as were more likely to interface with HIV-positive women during their routine clinic days. Thus, healthcare providers with experience in cervical cancer prevention and control, and those who provide care to HIV-positive women at their clinics were recruited and included for key informant interviews. From each clinic/unit, we ensured that a ward manager was included as a participant and medical officers were attached to the obstetrics and gynaecology department. Participants were recruited and interviewed until saturation was reached. Saturation was reached at 12 participants which was the final sample size for this study. Data collection tool and procedures We used KII guides to collect data from the healthcare providers. The interview guide contained questions in English language on the knowledge, practices, and perceptions of healthcare providers towards CCS among HIV-positive women (Table 1 ). The set of questions in this study was adapted from previous studies( 29 ). The tool was developed and agreed upon by all the researchers and later pretested among healthcare providers at Lira University Teaching Hospital. Following the pretesting, we made adjustments to ensure that the responses would capture the intended themes. The first, second, and third authors trained the research assistants about the tool and the data collection process. Our study was reviewed and given ethical clearance by the Lira University Research Ethics Committee (LUREC). The director of LRRH and the ward managers of the selected wards permitted us to conduct the study at the site. Before data collection, participants were purposively selected and approached individually by the researchers and given appointment dates and desired times for the interviews. Interviews were conducted by two research assistants who held Bachelor’s degrees in Midwifery and Public Health. Participants were informed about the purpose of the study and signed consent forms before the interviews were held. All the interviews were audio recorded and conducted in private clinical rooms without interference. To ensure rigor, interview questions were openly discussed with the participants using appropriate probes and the interviewer re-echoed some of the participant responses to ensure clarity. In addition, each interview was conducted by both research assistants as one would ask/rephrase the questions while the other would record and take notes. Table 1 Data collection tool S/N Interview question Probe 1 Please tell me about yourself (age in completed years, level of education, level of training, years of experience and cadre) 2 Tell me about cervical cancer and HIV/AIDS among women. ✓ What do you know about cervical cancer? (causes, signs and symptoms, diagnosis) ✓ How do you perceive cervical cancer among HIV women? (risk perception) 3 Tell me more about the kind of health education talks you provide to women with HIV. ✓ What do you include in the education package? ✓ How often are these education talks provided? 4 Please discuss some of the services you provide to HIV-positive women. ✓ Which services are provided to HIV-positive women? ✓ Which cervical cancer preventive services are provided at the facility? 5 Please discuss what you understand by cervical cancer screening. ✓ Tell me more about its importance ✓ Discuss some of the cervical cancer screening modalities provided at the facility. 6 Tell me about your impression of the utilisation of cervical cancer screening services by HIV-positive women ✓ Tell me about the turn-up and demand for CCS by HIV-positive clients ✓ Awareness about cervical cancer screening among HIV-positive women ✓ Some of the reasons why some women may or may not use the services ✓ Circumstances under which HIV-positive women may use CCS. 7 Please provide any suggestions on ways that screening utilisation can be improved Key informant interview guide subthemes of the knowledge, practices, and perceptions of health care providers on CCS among HIV-positive women in Lira City. Data analysis The audio-recorded interviews were transcribed verbatim by two authors and transcripts were proofread by the principal investigator to ensure correctness and completeness. The authors divided themselves into two groups and independently came up with codes which were later discussed and agreed upon by all the authors. Thematic content analysis was used in data analysis and all the step-by-step approaches were followed ( 30 ). Repetitive phrases and responses during analysis represented the codes. The coding and organization of the categories were supported by the NVivo (QSR International) software. The codes were later reorganized into related groups which enabled us to formulate the sub-themes and the themes. Most of the themes in this study were directly related to the study objectives. Verbal extracts of the participant responses were used to validate our study findings. Ethical considerations The study was approved by the Lira University Research Ethics Committee (LUREC-2022-5). Further approval was gained from the director of Lira Regional Referral Hospital (LRRH) and the ward managers of the clinics from where participants were recruited. All participants consented to audio recording and full participation in the study by signing written consent forms. Participants were identified by unique codes instead of real names. Results Characteristics of the participants Table 2 describes the key characteristics of the 12 participants. Eight of the participants were in the age group between 25 and 35 years and four were above 36 years. There were more females ( 9 ) than men ( 3 ), and slightly more participants had years of experience of less than 10 years ( 7 ). Most participants ( 9 ) were diploma holders, and there were more enrolled midwives than the rest of the cadres. Table 2 Characteristics of the participants . Variable (n = 12) Category Frequency (n = 12) Percentage (%) Age 25–35 years 8 66.6 36–50 years 2 16.7 Above 50 years 2 16.7 Sex Female 9 75.0 Male 3 25.0 Years of experience < 10 years 7 58.3 Above 10 years 5 41.7 Level of education Certificate 3 25.0 Diploma 9 75.0 Cadre Enrolled midwife 5 41.6 Enrolled nurse 3 25.0 Assistant Nursing Officer 2 16.7 Medical officer 2 16.7 Legend: characteristics of the healthcare providers in Lira City, Northern Uganda. Emergent themes From the research findings, we organized the data into three thematic areas. The themes that emerged include (I) Knowledge about cervical cancer and screening, (II) Practices of Healthcare providers towards CCS among HIV-positive women, and (III) Perceptions of healthcare providers on CCS among HIV-positive women. Healthcare providers’ perceptions of CCS among HIV-positive women have been distinctively organized into subthemes and sub-subthemes. Table 3 shows a summary of the themes, subthemes, and sub-subthemes that emerged from our findings. Table 3 Summary of the themes and subthemes Themes Subthemes Sub subthemes Knowledge about cervical cancer and screening a) Causes of cervical cancer b) Risk factors of cervical cancer c) Signs and symptoms of cervical cancer d) Diagnosis of cervical cancer Practices of Healthcare providers towards CCS among HIV positive women. Services provided to HIV-positive women Perceptions of Healthcare providers on CCS among HIV-positive women Impression about the utilisation of cervical cancer screening services by women a) Turn up for CCS services b) Awareness of CCS services c) Barriers and facilitators for CCS utilisation by HIV-positive women d) Suggestions on ways that CCS utilisation can be improved Legend: Summary of the themes, subthemes, and sub subthemes of the knowledge, practices, and perceptions of health care providers on CCS among HIV-positive women in Lira City. Theme 1: Knowledge about cervical cancer and screening Interviews were conducted with the study participants regarding their knowledge of cervical cancer which included causes, signs and symptoms, and diagnosis. In addition, the theme explored healthcare providers’ understanding of the risk factors of cervical cancer. Causes of cervical cancer Almost all participants knew about cervical cancer and its cause whereas the rest stated that the cause is unknown. In addition, some of the participants could not differentiate between the causes and risk factors for cervical cancer. A participant said; “It is caused by persistent infection of HPV and predisposing factors are smoking, multiple sexual partners.” Participant 8, Female. Risk factors of cervical cancer During the interviews about cervical cancer risk factors, it was revealed that most of the participants knew any of the risk factors for cervical cancer among women. Nearly all the participants mentioned multiple sexual partners as one of the risk factors. A participant said; “Okay, one is the virus, and also poor hygiene which results in UTIs. And also producing many children as well as having many partners.” Participant 3, Female. Signs and symptoms of cervical cancer Most participants knew the signs and symptoms of cervical cancer and cited lower abdominal pain, abnormal and irregular vaginal bleeding, and dyspareunia. “There can be complaints of lower abdominal pain, irregular bleeding, and maybe pain during sexual intercourse.” Participant 4, Female. Diagnosis for cervical cancer Diagnosis for cervical cancer can be done through HPV DNA testing, pap smear, Visual Inspection with Acetic acid (VIA), and biopsy. All the participants at least knew one method for cervical cancer screening as a way to diagnose cervical cancer. Noteworthy, VIA and HPV testing were the most mentioned methods. “Here we do HPV for the virus and VIA for lesions.” Participant 9, Female. “This is done through inserting vaginal spectrum and after removing the sample to take to cancer institute for confirmatory.” Participant 3, Female. Theme 2: Practices of Healthcare Providers towards CCS among HIV-positive women. Services provided to HIV-positive women Some of the services healthcare providers offer to HIV-positive clients during routine clinic days include health education, STI screening, cervical cancer screening, family planning services, and Antiretroviral Therapy. “Once we give them ARVs, we do cancer screening, family planning, and also health education talks.” Participant 7, Female. “Aah, we offer health education on diseases, cervical cancer screening for those who are eligible, STI screening, and family planning.” Participant 12, Female. On the other hand, during health education, the participants reported that they often teach their participants about viral load testing, the importance of screening for cervical cancer, drug adherence, healthy diet, and family planning. This is always done mostly during the routine ART clinic visits. “One is on nutrition because you cannot take drugs minus food, another one is about family planning and then also talking about cervical cancer screening.” Participant 5, Female. “Uhmmm, the common topic is viral load, then adherence, family planning, and many more risky behaviours such as smoking.” Participant 11, Male. “…these talks are done on a daily routine.” Participant 8, Female. Also, regarding the cervical cancer preventive services offered at the facility, participants reported that they provide cervical cancer screening, HPV vaccination for eligible girls, and cervical cancer awareness. “Vaccination of young girls with HPV vaccine, cervical cancer screening, and also health education talks.” Participant 7, Female. In addition, HPV testing and Visual Inspection with Acetic acid (VIA) were the most reported cervical cancer screening modalities “Aaaah, we have HPV self-testing and also VIA.” Participant 4, Female. Theme 3: Perceptions of Healthcare providers on CCS among HIV-positive women Impression about the utilisation of cervical cancer screening services by women Turn up for CCS services Reportedly, the turn-up and demand for cervical cancer screening services by HIV-positive women have notably improved due to healthcare provider recommendations, increased awareness, and continuous appointments for CCS services. “Here at the referral, the turn up is good and also the demand is high since they are always reminded and many referrals are made here.” Participant 8, Female. Awareness of CCS services Most of the participants thought that HIV-positive women are aware of the CCS services which have led to improved turn up for screening. It is also a result of the routine health education talks provided to these women at the clinics. “They are aware due to daily reminders given.” Participant 8, Female. Barriers and facilitators for CCS utilisation by HIV-positive women Participants also cited frustrations and hindrances that deter HIV-positive women from seeking and utilizing cervical cancer services at the health facility. Some of the barriers included long waiting hours, long distances to the facility, and the perceived negative attitude of some health providers that provide these services. “I think many are discouraged more so if the turn-up is big and they have to wait for many hours to be attended to.” Participant 12, Female. “I think long distances to the health facility and maybe the attitude some have on health providers that most of them are rude.” Participant 5, Female. Regardless of the different barriers HIV-positive women face while seeking CCS, it was noted that continuous awareness creation through health education, presence of signs and symptoms and the desire to stay healthy motivate them to use these services. “First of all, the awareness given to them makes them come, and then also they know that they are supposed to test based on their conditions they have.” Participant 7, Female. “Most of them come after getting the symptoms, so they rush for checkups and treatment.” Participant 9, Female. “My observation is that I think women nowadays are concerned about their lives since they are aware of dangers that may result if not screened.” Participant 12, Female. Suggestions on ways that CCS utilisation can be improved As suggested by most of the participants, CCS can be improved through continuous health education on cervical cancer, community sensitization, and ensuring privacy for the women who go for screening services at the health facility. “Maybe intensifying health education talks, and also educating the community more about dangers of not screening for cervical cancer.” Participant 9, Female. “I think they can put more rooms for privacy….” Participant 3, Female. “Uhmm, I think this could be through Continuous Health Education and sensitization of the community about the benefits of cervical cancer screening services.” Participant 4, Female. Discussion Our study provides deeper evidence of the knowledge, practices, and perceptions of the healthcare providers on cervical cancer screening among HIV-positive women, the perceived extent of CCS utilization among HIV-positive women, and possible solutions to CCS utilization improvement. Participants in our study were knowledgeable about cervical cancer and cervical cancer screening which was expressed in terms of causes, risk factors, signs and symptoms as well as diagnostic methods of cervical cancer among women. Study participants knew persistent HPV infection as the cause of cervical cancer, knew multiple sexual partners as one of the risk factors, knew abnormal and irregular vaginal bleeding and dyspareunia as the signs and symptoms, and mentioned VIA and HPV testing as the cervical cancer diagnostic methods. Our findings are consistent with those obtained from Northern Uganda( 31 ) and Nigeria( 22 ) and disagree with those obtained among healthcare providers in Saudi Arabia( 32 ). However, only a few had misconceptions about the signs and symptoms of cervical cancer. The findings imply that the healthcare providers are making substantial contributions concerning patient education on cervical cancer and cervical cancer screening which could have led to improvement in CCS utilization( 27 ). The good knowledge of the participants in this study could have been due to prior cervical cancer training at the facility which could have boosted their understanding of cervical cancer. Since nurses, midwives, and medical officers are always interacting with HIV-positive women, they must have current knowledge about cervical cancer to disseminate accurate information. Timely refresher pieces of training and the provision of updated guidelines on cervical cancer screening would positively impact the knowledge levels of healthcare providers. Our results demonstrate the different services healthcare providers offer to HIV-positive women during the routine clinic days and at outreaches. Most of the participants reported providing health education, STI screening, cervical cancer screening, family planning services, and Antiretroviral Therapy to HIV-positive women. Additionally, health education provided by healthcare providers entails the need for viral load testing, the importance of screening for cervical cancer, drug adherence, a healthy diet, and family planning on a routine basis. Prior studies have shown how the provision of health education translates into improved service utilization of CCS services( 33 , 34 ). Overall, our findings show that HIV-positive women receive a variety of services from the facility but it’s not clear whether all those services are obtained from the same clinic. This highlights the need to always link HIV-positive women to specific clinics where those services can be obtained. Alternatively, these services can be integrated into one clinic and provided as a package to reduce missing out on some of the services. Cervical cancer prevention services commonly provided by healthcare workers included cervical cancer screening, HPV vaccination for eligible girls, and cervical cancer awareness. Specifically, HPV testing and Visual Inspection with Acetic acid (VIA) were the most reported cervical cancer screening modalities. Notably, cancer prevention by HPV vaccination among eligible girls is still low( 25 , 35 ) in Northern Uganda despite improved CCS utilisation and cervical cancer awareness in the region( 27 , 36 , 37 ). Baseline screening using HPV DNA testing and VIA is an effective way for triage and detection of abnormal cervical lesions among women in low- and middle-income countries( 12 , 38 ). Thus, these screening tests can be adopted at all levels of healthcare in Uganda to increase CCS coverage. Based on our findings, participants reported increasing turn-up and demand for cervical cancer screening services among HIV-positive women. This could be attributed to healthcare provider recommendations( 39 , 40 ), increased awareness( 27 , 41 ) and continuous appointments for CCS( 39 ) services at the facility. Repetitive reminders and referrals significantly create awareness about the services which not only facilitates patient timeliness but also efficient utilization of the available services( 42 ). Our findings indicate an increasing uptake of CCS which could be a result of the efforts by the health sector and its partners in the region. It also implies the need to increase and create more opportunities for screening among eligible women, both at facility and community levels. There is a need to adopt more effective and efficient cervical cancer screening techniques such as self-sample collection for HPV DNA testing, visual inspection with acetic acid, and referral for treatment of any detected abnormal cervical lesions at all levels. Our study suggests that HIV-positive women are more likely to undergo cervical cancer screening due to continuous awareness creation through health education, the presence of signs and symptoms, and the desire to maintain good health. Previous studies are in agreement with our findings( 43 – 45 ). The findings imply that some women only screen following the onset of symptoms which may be detected when the disease has already advanced. Moreover, the high mortality rate due to cervical cancer is attributed to the diagnosis of cervical cancer during the late stage where treatment is impossible( 13 ). Although existing health education interventions educate the public on notable signs and symptoms of cervical cancer, women should also be encouraged to go for screening even in the absence of the symptoms. Nevertheless, cervical cancer screening is reportedly hindered by long waiting hours, long distances to the facility, and the perceived negative attitude of some health providers that provide these services. This is consistent with results from previous studies in Uganda( 45 , 46 ). The findings imply that the available CCS services are unsatisfactory since they aren’t easily accessible as well as due to the delays while seeking those services thus poor quality care. As a result, service utilization will be negatively impacted due to poor quality of care( 47 ). Therefore, there is a need to decentralize cervical cancer screening services and adopt and encourage self-cervical cancer screening in low-resource settings. This will help decongest the main screening centres and improve accessibility. To enhance the usage of cervical cancer screening services among HIV-positive women, participants were provided with an opportunity to propose effective methods for the implementation of these services. This exercise aimed to gather valuable insights from individuals with relevant experience or knowledge, which could be utilized in designing and executing targeted interventions that could increase the uptake of cervical cancer screening among this specific population. They suggested that CCS can be improved through continuous health education on cervical cancer, community sensitization, and ensuring privacy for the women who go for screening services at the health facility. By considering the suggestions, it is hoped that healthcare providers and policymakers can create more tailored and effective strategies that address the unique challenges and barriers faced by HIV-positive women when accessing cervical cancer screening services. Study limitations Like all qualitative studies, our study used a small sample size hence our findings may not be generalizable to larger settings but rather transferable to similar settings. Secondly, we did not include community healthcare providers who are nearer to the community and could have unique perceptions and practices. Conclusion and recommendations Healthcare providers knew cervical cancer screening by HPV testing and Visual Inspection with Acetic acid and provided routine health education on screening, and cervical cancer screening to HIV-positive women. They perceived increased demand for CCS services by HIV-positive women, which is attributed to their increased awareness, the presence of signs and symptoms, and their desire to maintain optimal health. Despite several hindering factors, such as long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers, the practice of cervical cancer screening can be improved by reducing waiting times, increasing access to healthcare facilities, and ensuring that patients feel comfortable throughout the screening process. Declarations Acknowledgement The authors wish to acknowledge the study participants who spared time to participate in the study. Additionally, we would like to thank our research assistants who collected this valuable data. Availability of materials and methods All relevant materials and methods concerning the study will be availed on request. Conflict of interest The authors declare no competing interests. Funding The authors did not receive any funding support or grant to conduct the study. 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Pan Afr Med J. ;31(1) Layet F, Murungi T, Ashaba N, Kigongo E, Opollo MS (2024) Factors associated with utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira regional referral hospital, Northern Uganda. BMC Womens Health 24(1):114 Sarah Maria N, Olwit C, Kaggwa MM, Nabirye RC, Ngabirano TD (2022) Cervical cancer screening among HIV-positive women in urban Uganda: a cross-sectional study. BMC Womens Health 22(1):148 Ndikom CM, Ofi BA (2012) Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: a qualitative study. Reproductive Health 9(1):11 Ritchie J, Lewis J, Nicholls CM, Ormston R (2013) Qualitative research practice: A guide for social science students. sage, and researchers Obol JH, Lin S, Obwolo MJ, Harrison R, Richmond R (2021) Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda. BMC Cancer 21(1):110 Heena H, Durrani S, AlFayyad I, Riaz M, Tabasim R, Parvez G et al (2019) Knowledge, attitudes, and practices towards cervical cancer and screening amongst female healthcare professionals: a cross-sectional study. Journal of oncology. ;2019 Abu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM (2020) The role of health education on cervical cancer screening uptake at selected health centres in Addis Ababa. PLoS ONE 15(10):e0239580 Agide FD, Garmaroudi G, Sadeghi R, Shakibazadeh E, Yaseri M, Koricha ZB et al (2018) A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake. Eur J Pub Health 28(6):1156–1162 Odongo Ojok I, Ogwal JB, Wwesige B, Bongomin F, Akello F (2023) Factors Associated with the Human Papillomavirus Vaccine Coverage in Gulu District, Uganda. Adolesc Health Med Ther. :87–96 Sam O (2022) Assessing Knowledge, Attitude, and Practices of Women of Reproductive Age (15–49) Towards Cervical Cancer Screening in Adyel Division, Adyel Ward, Lira City West Division, Lira City. J Biomed Biosens 2(2):11–30 Gwokyalya GB, Ayebazibwe A, Kinyera C, Nabanoba S, Pebalo FP (2022) Utilization of cervical cancer screening services and associated factors among HIV-positive women receiving care at an antiretroviral therapy clinic in Gulu Regional Referral Hospital Sherris J, Wittet S, Kleine A, Sellors J, Luciani S, Sankaranarayanan R et al (2009) Evidence-based, alternative cervical cancer screening approaches in low-resource settings. Int Perspect Sex reproductive health 35(3):147–152 Musa J, Achenbach CJ, O’Dwyer LC, Evans CT, McHugh M, Hou L et al (2017) Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS ONE 12(9):e0183924 Black E, Hyslop F, Richmond R (2019) Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health 19(1):108 Abugu LI, Nwagu EN (2021) Awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria. Pan Afr Med J 39:200 Tavasoli SM, Pefoyo AJK, Hader J, Lee A, Kupets R (2016) Impact of invitation and reminder letters on cervical cancer screening participation rates in an organized screening program. Prev Med 88:230–236 Thembekile Shato UN, Boakye EA, Fu QJ, Iwelunmor J (2023) Anne Sebert Kuhlmann. Uptake of cervical cancer screening services in urban Zimbabwe: Healthcare provider perspectives [abstract] Driscoll SD (2016) Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence. Women Health 56(4):448–467 Ndejjo R, Mukama T, Kiguli J, Musoke D (2017) Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: a qualitative study. BMJ open 7(6):e016282 Li M, Nyabigambo A, Navvuga P, Nuwamanya E, Nuwasiima A, Kaganda P et al (2017) Acceptability of cervical cancer screening using visual inspection among women attending a childhood immunization clinic in Uganda. Papillomavirus Res 4:17–21 Harris B, Goudge J, Ataguba JE, McIntyre D, Nxumalo N, Jikwana S et al (2011) Inequities in access to health care in South Africa. J Public Health Policy 32(Suppl 1):S102–S123 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5000041","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":347025670,"identity":"eb381b93-41cd-4af9-b596-149b80dedb62","order_by":0,"name":"Florence Layet","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Florence","middleName":"","lastName":"Layet","suffix":""},{"id":347025671,"identity":"170546fe-c602-4710-90a9-d00eeb3863ac","order_by":1,"name":"Tom Murungi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYFADZsbGBx8qbIAsxsYD+BTyILQwNxvOOJMG0tJApBYG9jZp3rbDYCZeLfbs3ambefcczpN3ZwRpOW+3tv0w0JYam2ictvCc3Xab59nhYsPDjM2Wc87dTt52JhGo5VhabgMuLRK5QC0HDidubGZsvPGm7Hay2QGgFsaGw0RpaZDgYTuXbHb+IZFa5jMzNknytB2wM7tByJYzZ7fdnHMgPXEDMyMokJMTzG4AbUnA4xf29t5tN94csE6c33/8ITAq7ezNzqcDGTU2OLXAgcEBCJ0IVplASDkIyEMNtSdG8SgYBaNgFIwsAAChkmwcBfxmYQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0004-4693-7760","institution":"Lira University","correspondingAuthor":true,"prefix":"","firstName":"Tom","middleName":"","lastName":"Murungi","suffix":""},{"id":347025672,"identity":"6cc65359-d75d-47f5-97dc-f146aa20354e","order_by":2,"name":"Nasser Ashaba","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Nasser","middleName":"","lastName":"Ashaba","suffix":""},{"id":347028266,"identity":"67660b59-7d11-4acc-a15a-29940ba1446c","order_by":3,"name":"Mirembe Renniter Nakayita","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Mirembe","middleName":"Renniter","lastName":"Nakayita","suffix":""},{"id":347028267,"identity":"db985aef-28a8-4af8-9298-f1000dd136c0","order_by":4,"name":"Eustes Kigongo","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Eustes","middleName":"","lastName":"Kigongo","suffix":""},{"id":347028268,"identity":"eb44084f-36f2-4389-a04f-b6910ed90247","order_by":5,"name":"Marc Sam Opollo","email":"","orcid":"","institution":"Lira University","correspondingAuthor":false,"prefix":"","firstName":"Marc","middleName":"Sam","lastName":"Opollo","suffix":""}],"badges":[],"createdAt":"2024-08-29 21:48:33","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5000041/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5000041/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63780063,"identity":"a06d13c9-2cce-4dd8-be03-15b906d09afd","added_by":"auto","created_at":"2024-09-02 09:38:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":703239,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5000041/v1/594a3ecf-5791-444a-bb30-fbe8fccc17e9.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eKnowledge, practices, and perceptions of the healthcare providers on cervical cancer screening among HIV-positive women at Lira Regional Referral Hospital, Lira City.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains a global burden and is by far one of the major causes of premature death among women in the reproductive age(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Low- and middle-income countries bear the highest burden of cervical cancer incidences and deaths among women(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Sub-Saharan Africa, specifically Eastern and Southern Africa contributes the highest cervical cancer deaths and incidences as well as the highest burden of high-risk Human papillomavirus(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Infection with the Human Papillomavirus is responsible for the majority of cervical cancers with HPV types 16 and 18 causing about 70% of cervical cancers(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, women infected with HIV are at higher risk of developing cancer of the cervix (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and the disease is frequent among those aged 18\u0026ndash;49 years(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Annually, about 6,959 new cervical cancer cases are diagnosed with about 4,607 cervical cancer deaths among women in Uganda(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNearly all cervical cancers can be prevented through HPV vaccination of all eligible girls, HPV testing, routine cervical cancer screening as well as early initiation of treatment for precancerous lesions(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). To reduce cervical cancer incidences and deaths, the World Health Organization (WHO) recommends regular cervical cancer screening for 70% of women and treatment for 90% of those with pre-cancer lesions(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, frequent cervical cancer screening among women living with HIV from 25 years of age is recommended(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Uganda recommends annual cervical cancer screening for women living with HIV(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Unfortunately, screening among women living with HIV is still low and affected by both systematic, structural, and contextual factors(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealthcare providers, especially nurses, gynaecologists, medical officers and midwives in Uganda are the primary providers of cervical cancer screening services(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). They have more opportunities to counsel HIV-positive women on CCS because they spend more quality time with them(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). They are crucial in preventing cervical cancer by knowing screening guidelines, risk factors, screening technologies, interpretation of results, follow-up strategies, and patient counselling(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Thus, it is of utmost importance that healthcare providers have better practices and adequate knowledge towards cervical cancer screening. Their expertise is vital in detecting cervical abnormalities early and managing them effectively, which ultimately reduces the incidence of, and mortality associated with this disease. Literature suggests that the knowledge of healthcare providers on cervical cancer screening is suboptimal (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which sabotages the global targets for cervical cancer mitigation. However, evidence from some studies shows that healthcare providers are knowledgeable and are significantly contributing to cervical cancer screening(\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCervical cancer prevention measures in Lira district such as HPV vaccination for young girls and cervical cancer screening have markedly been suboptimal(\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) despite the existing provider-led interventions(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Notably, data are plausible regarding the perceptions of health providers towards CCS among HIV-positive women. Moreover, it is recommended that the perspectives of the healthcare providers be explored qualitatively according to a previous study in Uganda(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This study provides valuable insights into the issue and underlines the need for action to improve cervical cancer prevention and management in Lira City and similar settings. It is against this background that our study explored the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women in Lira City.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\n\u003cp\u003eThis was a cross-sectional qualitative study that used thematic analysis to identify the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women in Lira City. Key informant interviews (KII\u0026rsquo;s) were used to collect data among healthcare care providers at Lira Regional Referral Hospital who were purposively selected based on (I) the Department/unit where they worked and (II) Cadre. The study used an explanatory model to investigate why HIV-positive women don\u0026rsquo;t use CCS services and understand the knowledge and practices of healthcare providers on CCS among HIV-positive women.\u003c/p\u003e\n\u003cp\u003eThe study was conducted among healthcare providers at Lira Regional Referral Hospital (LRRH), Lira City, Northern Uganda in June 2023. Routine cervical cancer screening services at LRRH are provided at the cervical cancer unit at a free cost and the clinic has 5 working days a week. HIV-positive women requiring CCS services from the ART clinic, family planning unit, and Early Infant Diagnosis (EID) clinic at LRRH are sent to the cervical cancer screening unit. Screening is conducted majorly by nurses and midwives and rarely by a medical officer. Other cervical screening opportunities in Lira City are one by way of outreaches which are either part of the hospital program or supported by non-government organizations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy participants\u003c/h2\u003e\n\u003cp\u003eThe study participants comprised Healthcare providers who offer care to HIV-positive women at LRRH, Lira City. In this study, healthcare providers with experience in cervical cancer prevention and control, and those who provide care to HIV-positive women at their clinics were included for key informant interviews. Specifically, nurses, midwives, and medical officers who are at the forefront of the implementation of cervical cancer screening were included in the study. Participants were most likely to have been working in antenatal, EID, family planning, and cervical cancer screening clinics. We did not recruit healthcare providers who don\u0026rsquo;t interact with HIV-positive clients for a long time such as laboratory technicians and sonographers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eSample size and sampling procedure\u003c/h2\u003e\n\u003cp\u003eWe purposely selected LRRH because it is a regional referral hospital with the capacity to conduct cervical cancer screening and by the fact that they serve a large number of HIV-positive clients at their clinics. Within the hospital, we purposively selected four units/clinics, i.e., antenatal, EID, family planning, and cervical cancer screening clinics because they had healthcare providers with practical experience in cervical cancer screening as well as were more likely to interface with HIV-positive women during their routine clinic days. Thus, healthcare providers with experience in cervical cancer prevention and control, and those who provide care to HIV-positive women at their clinics were recruited and included for key informant interviews. From each clinic/unit, we ensured that a ward manager was included as a participant and medical officers were attached to the obstetrics and gynaecology department. Participants were recruited and interviewed until saturation was reached. Saturation was reached at 12 participants which was the final sample size for this study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection tool and procedures\u003c/h2\u003e\n\u003cp\u003eWe used KII guides to collect data from the healthcare providers. The interview guide contained questions in English language on the knowledge, practices, and perceptions of healthcare providers towards CCS among HIV-positive women (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The set of questions in this study was adapted from previous studies(\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). The tool was developed and agreed upon by all the researchers and later pretested among healthcare providers at Lira University Teaching Hospital. Following the pretesting, we made adjustments to ensure that the responses would capture the intended themes. The first, second, and third authors trained the research assistants about the tool and the data collection process. Our study was reviewed and given ethical clearance by the Lira University Research Ethics Committee (LUREC). The director of LRRH and the ward managers of the selected wards permitted us to conduct the study at the site. Before data collection, participants were purposively selected and approached individually by the researchers and given appointment dates and desired times for the interviews. Interviews were conducted by two research assistants who held Bachelor\u0026rsquo;s degrees in Midwifery and Public Health. Participants were informed about the purpose of the study and signed consent forms before the interviews were held. All the interviews were audio recorded and conducted in private clinical rooms without interference. To ensure rigor, interview questions were openly discussed with the participants using appropriate probes and the interviewer re-echoed some of the participant responses to ensure clarity. In addition, each interview was conducted by both research assistants as one would ask/rephrase the questions while the other would record and take notes.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eData collection tool\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eS/N\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInterview question\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eProbe\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePlease tell me about yourself (age in completed years, level of education, level of training, years of experience and cadre)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTell me about cervical cancer and HIV/AIDS among women.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ What do you know about cervical cancer? (causes, signs and symptoms, diagnosis)\u003c/p\u003e\n\u003cp\u003e✓ How do you perceive cervical cancer among HIV women? (risk perception)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTell me more about the kind of health education talks you provide to women with HIV.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ What do you include in the education package?\u003c/p\u003e\n\u003cp\u003e✓ How often are these education talks provided?\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePlease discuss some of the services you provide to HIV-positive women.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Which services are provided to HIV-positive women?\u003c/p\u003e\n\u003cp\u003e✓ Which cervical cancer preventive services are provided at the facility?\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePlease discuss what you understand by cervical cancer screening.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Tell me more about its importance\u003c/p\u003e\n\u003cp\u003e✓ Discuss some of the cervical cancer screening modalities provided at the facility.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTell me about your impression of the utilisation of cervical cancer screening services by HIV-positive women\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e✓ Tell me about the turn-up and demand for CCS by HIV-positive clients\u003c/p\u003e\n\u003cp\u003e✓ Awareness about cervical cancer screening among HIV-positive women\u003c/p\u003e\n\u003cp\u003e✓ Some of the reasons why some women may or may not use the services\u003c/p\u003e\n\u003cp\u003e✓ Circumstances under which HIV-positive women may use CCS.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePlease provide any suggestions on ways that screening utilisation can be improved\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e Key informant interview guide subthemes of the knowledge, practices, and perceptions of health care providers on CCS among HIV-positive women in Lira City.\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eThe audio-recorded interviews were transcribed verbatim by two authors and transcripts were proofread by the principal investigator to ensure correctness and completeness. The authors divided themselves into two groups and independently came up with codes which were later discussed and agreed upon by all the authors. Thematic content analysis was used in data analysis and all the step-by-step approaches were followed (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). Repetitive phrases and responses during analysis represented the codes. The coding and organization of the categories were supported by the NVivo (QSR International) software. The codes were later reorganized into related groups which enabled us to formulate the sub-themes and the themes. Most of the themes in this study were directly related to the study objectives. Verbal extracts of the participant responses were used to validate our study findings.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the Lira University Research Ethics Committee (LUREC-2022-5). Further approval was gained from the director of Lira Regional Referral Hospital (LRRH) and the ward managers of the clinics from where participants were recruited. All participants consented to audio recording and full participation in the study by signing written consent forms. Participants were identified by unique codes instead of real names.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the participants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describes the key characteristics of the 12 participants. Eight of the participants were in the age group between 25 and 35 years and four were above 36 years. There were more females (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) than men (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and slightly more participants had years of experience of less than 10 years (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Most participants (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) were diploma holders, and there were more enrolled midwives than the rest of the cadres.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics of the participants\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCertificate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCadre\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnrolled midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnrolled nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssistant Nursing Officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical officer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLegend: characteristics of the healthcare providers in Lira City, Northern Uganda.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEmergent themes\u003c/h2\u003e \u003cp\u003eFrom the research findings, we organized the data into three thematic areas. The themes that emerged include (I) Knowledge about cervical cancer and screening, (II) Practices of Healthcare providers towards CCS among HIV-positive women, and (III) Perceptions of healthcare providers on CCS among HIV-positive women. Healthcare providers\u0026rsquo; perceptions of CCS among HIV-positive women have been distinctively organized into subthemes and sub-subthemes. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows a summary of the themes, subthemes, and sub-subthemes that emerged from our findings.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of the themes and subthemes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSub subthemes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge about cervical cancer and screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ea) Causes of cervical cancer\u003c/p\u003e \u003cp\u003eb) Risk factors of cervical cancer\u003c/p\u003e \u003cp\u003ec) Signs and symptoms of cervical cancer\u003c/p\u003e \u003cp\u003ed) Diagnosis of cervical cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractices of Healthcare providers towards CCS among HIV positive women.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eServices provided to HIV-positive women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceptions of Healthcare providers on CCS among HIV-positive women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpression about the utilisation of cervical cancer screening services by women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ea) Turn up for CCS services\u003c/p\u003e \u003cp\u003eb) Awareness of CCS services\u003c/p\u003e \u003cp\u003ec) Barriers and facilitators for CCS utilisation by HIV-positive women\u003c/p\u003e \u003cp\u003ed) Suggestions on ways that CCS utilisation can be improved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003e Legend: Summary of the themes, subthemes, and sub subthemes of the knowledge, practices, and perceptions of health care providers on CCS among HIV-positive women in Lira City.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Knowledge about cervical cancer and screening\u003c/h2\u003e \u003cp\u003eInterviews were conducted with the study participants regarding their knowledge of cervical cancer which included causes, signs and symptoms, and diagnosis. In addition, the theme explored healthcare providers\u0026rsquo; understanding of the risk factors of cervical cancer.\u003c/p\u003e \u003cp\u003eCauses of cervical cancer\u003c/p\u003e \u003cp\u003eAlmost all participants knew about cervical cancer and its cause whereas the rest stated that the cause is unknown. In addition, some of the participants could not differentiate between the causes and risk factors for cervical cancer.\u003c/p\u003e \u003cp\u003eA participant said;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It is caused by persistent infection of HPV and predisposing factors are smoking, multiple sexual partners.\u0026rdquo; Participant 8, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRisk factors of cervical cancer\u003c/p\u003e \u003cp\u003eDuring the interviews about cervical cancer risk factors, it was revealed that most of the participants knew any of the risk factors for cervical cancer among women. Nearly all the participants mentioned multiple sexual partners as one of the risk factors.\u003c/p\u003e \u003cp\u003eA participant said;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Okay, one is the virus, and also poor hygiene which results in UTIs. And also producing many children as well as having many partners.\u0026rdquo; Participant 3, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSigns and symptoms of cervical cancer\u003c/p\u003e \u003cp\u003eMost participants knew the signs and symptoms of cervical cancer and cited lower abdominal pain, abnormal and irregular vaginal bleeding, and dyspareunia.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;There can be complaints of lower abdominal pain, irregular bleeding, and maybe pain during sexual intercourse.\u0026rdquo; Participant 4, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDiagnosis for cervical cancer\u003c/p\u003e \u003cp\u003eDiagnosis for cervical cancer can be done through HPV DNA testing, pap smear, Visual Inspection with Acetic acid (VIA), and biopsy. All the participants at least knew one method for cervical cancer screening as a way to diagnose cervical cancer. Noteworthy, VIA and HPV testing were the most mentioned methods.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Here we do HPV for the virus and VIA for lesions.\u0026rdquo; Participant 9, Female.\u003c/em\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;This is done through inserting vaginal spectrum and after removing the sample to take to cancer institute for confirmatory.\u0026rdquo; Participant 3, Female.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 2: Practices of Healthcare Providers towards CCS among HIV-positive women.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eServices provided to HIV-positive women\u003c/h2\u003e \u003cp\u003eSome of the services healthcare providers offer to HIV-positive clients during routine clinic days include health education, STI screening, cervical cancer screening, family planning services, and Antiretroviral Therapy.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Once we give them ARVs, we do cancer screening, family planning, and also health education talks.\u0026rdquo; Participant 7, Female.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e \u0026ldquo;Aah, we offer health education on diseases, cervical cancer screening for those who are eligible, STI screening, and family planning.\u0026rdquo; Participant 12, Female.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOn the other hand, during health education, the participants reported that they often teach their participants about viral load testing, the importance of screening for cervical cancer, drug adherence, healthy diet, and family planning. This is always done mostly during the routine ART clinic visits.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;One is on nutrition because you cannot take drugs minus food, another one is about family planning and then also talking about cervical cancer screening.\u0026rdquo; Participant 5, Female.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Uhmmm, the common topic is viral load, then adherence, family planning, and many more risky behaviours such as smoking.\u0026rdquo; Participant 11, Male.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;\u0026hellip;these talks are done on a daily routine.\u0026rdquo; Participant 8, Female.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAlso, regarding the cervical cancer preventive services offered at the facility, participants reported that they provide cervical cancer screening, HPV vaccination for eligible girls, and cervical cancer awareness.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Vaccination of young girls with HPV vaccine, cervical cancer screening, and also health education talks.\u0026rdquo; Participant 7, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition, HPV testing and Visual Inspection with Acetic acid (VIA) were the most reported cervical cancer screening modalities\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Aaaah, we have HPV self-testing and also VIA.\u0026rdquo; Participant 4, Female.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Perceptions of Healthcare providers on CCS among HIV-positive women\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eImpression about the utilisation of cervical cancer screening services by women\u003c/h2\u003e \u003cp\u003eTurn up for CCS services\u003c/p\u003e \u003cp\u003eReportedly, the turn-up and demand for cervical cancer screening services by HIV-positive women have notably improved due to healthcare provider recommendations, increased awareness, and continuous appointments for CCS services.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e \u0026ldquo;Here at the referral, the turn up is good and also the demand is high since they are always reminded and many referrals are made here.\u0026rdquo; Participant 8, Female.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAwareness of CCS services\u003c/p\u003e \u003cp\u003eMost of the participants thought that HIV-positive women are aware of the CCS services which have led to improved turn up for screening. It is also a result of the routine health education talks provided to these women at the clinics.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They are aware due to daily reminders given.\u0026rdquo; Participant 8, Female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBarriers and facilitators for CCS utilisation by HIV-positive women\u003c/p\u003e \u003cp\u003e Participants also cited frustrations and hindrances that deter HIV-positive women from seeking and utilizing cervical cancer services at the health facility. Some of the barriers included long waiting hours, long distances to the facility, and the perceived negative attitude of some health providers that provide these services.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think many are discouraged more so if the turn-up is big and they have to wait for many hours to be attended to.\u0026rdquo; Participant 12, Female.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think long distances to the health facility and maybe the attitude some have on health providers that most of them are rude.\u0026rdquo; Participant 5, Female.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRegardless of the different barriers HIV-positive women face while seeking CCS, it was noted that continuous awareness creation through health education, presence of signs and symptoms and the desire to stay healthy motivate them to use these services.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;First of all, the awareness given to them makes them come, and then also they know that they are supposed to test based on their conditions they have.\u0026rdquo; Participant 7, Female.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Most of them come after getting the symptoms, so they rush for checkups and treatment.\u0026rdquo; Participant 9, Female.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;My observation is that I think women nowadays are concerned about their lives since they are aware of dangers that may result if not screened.\u0026rdquo; Participant 12, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSuggestions on ways that CCS utilisation can be improved\u003c/p\u003e \u003cp\u003eAs suggested by most of the participants, CCS can be improved through continuous health education on cervical cancer, community sensitization, and ensuring privacy for the women who go for screening services at the health facility.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Maybe intensifying health education talks, and also educating the community more about dangers of not screening for cervical cancer.\u0026rdquo; Participant 9, Female.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I think they can put more rooms for privacy\u0026hellip;.\u0026rdquo; Participant 3, Female.\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Uhmm, I think this could be through Continuous Health Education and sensitization of the community about the benefits of cervical cancer screening services.\u0026rdquo; Participant 4, Female.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study provides deeper evidence of the knowledge, practices, and perceptions of the healthcare providers on cervical cancer screening among HIV-positive women, the perceived extent of CCS utilization among HIV-positive women, and possible solutions to CCS utilization improvement.\u003c/p\u003e \u003cp\u003eParticipants in our study were knowledgeable about cervical cancer and cervical cancer screening which was expressed in terms of causes, risk factors, signs and symptoms as well as diagnostic methods of cervical cancer among women. Study participants knew persistent HPV infection as the cause of cervical cancer, knew multiple sexual partners as one of the risk factors, knew abnormal and irregular vaginal bleeding and dyspareunia as the signs and symptoms, and mentioned VIA and HPV testing as the cervical cancer diagnostic methods. Our findings are consistent with those obtained from Northern Uganda(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and Nigeria(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and disagree with those obtained among healthcare providers in Saudi Arabia(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). However, only a few had misconceptions about the signs and symptoms of cervical cancer. The findings imply that the healthcare providers are making substantial contributions concerning patient education on cervical cancer and cervical cancer screening which could have led to improvement in CCS utilization(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The good knowledge of the participants in this study could have been due to prior cervical cancer training at the facility which could have boosted their understanding of cervical cancer. Since nurses, midwives, and medical officers are always interacting with HIV-positive women, they must have current knowledge about cervical cancer to disseminate accurate information. Timely refresher pieces of training and the provision of updated guidelines on cervical cancer screening would positively impact the knowledge levels of healthcare providers.\u003c/p\u003e \u003cp\u003eOur results demonstrate the different services healthcare providers offer to HIV-positive women during the routine clinic days and at outreaches. Most of the participants reported providing health education, STI screening, cervical cancer screening, family planning services, and Antiretroviral Therapy to HIV-positive women. Additionally, health education provided by healthcare providers entails the need for viral load testing, the importance of screening for cervical cancer, drug adherence, a healthy diet, and family planning on a routine basis. Prior studies have shown how the provision of health education translates into improved service utilization of CCS services(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Overall, our findings show that HIV-positive women receive a variety of services from the facility but it\u0026rsquo;s not clear whether all those services are obtained from the same clinic. This highlights the need to always link HIV-positive women to specific clinics where those services can be obtained. Alternatively, these services can be integrated into one clinic and provided as a package to reduce missing out on some of the services.\u003c/p\u003e \u003cp\u003eCervical cancer prevention services commonly provided by healthcare workers included cervical cancer screening, HPV vaccination for eligible girls, and cervical cancer awareness. Specifically, HPV testing and Visual Inspection with Acetic acid (VIA) were the most reported cervical cancer screening modalities. Notably, cancer prevention by HPV vaccination among eligible girls is still low(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) in Northern Uganda despite improved CCS utilisation and cervical cancer awareness in the region(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Baseline screening using HPV DNA testing and VIA is an effective way for triage and detection of abnormal cervical lesions among women in low- and middle-income countries(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Thus, these screening tests can be adopted at all levels of healthcare in Uganda to increase CCS coverage.\u003c/p\u003e \u003cp\u003eBased on our findings, participants reported increasing turn-up and demand for cervical cancer screening services among HIV-positive women. This could be attributed to healthcare provider recommendations(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), increased awareness(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) and continuous appointments for CCS(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) services at the facility. Repetitive reminders and referrals significantly create awareness about the services which not only facilitates patient timeliness but also efficient utilization of the available services(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Our findings indicate an increasing uptake of CCS which could be a result of the efforts by the health sector and its partners in the region. It also implies the need to increase and create more opportunities for screening among eligible women, both at facility and community levels. There is a need to adopt more effective and efficient cervical cancer screening techniques such as self-sample collection for HPV DNA testing, visual inspection with acetic acid, and referral for treatment of any detected abnormal cervical lesions at all levels.\u003c/p\u003e \u003cp\u003eOur study suggests that HIV-positive women are more likely to undergo cervical cancer screening due to continuous awareness creation through health education, the presence of signs and symptoms, and the desire to maintain good health. Previous studies are in agreement with our findings(\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). The findings imply that some women only screen following the onset of symptoms which may be detected when the disease has already advanced. Moreover, the high mortality rate due to cervical cancer is attributed to the diagnosis of cervical cancer during the late stage where treatment is impossible(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Although existing health education interventions educate the public on notable signs and symptoms of cervical cancer, women should also be encouraged to go for screening even in the absence of the symptoms.\u003c/p\u003e \u003cp\u003eNevertheless, cervical cancer screening is reportedly hindered by long waiting hours, long distances to the facility, and the perceived negative attitude of some health providers that provide these services. This is consistent with results from previous studies in Uganda(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The findings imply that the available CCS services are unsatisfactory since they aren\u0026rsquo;t easily accessible as well as due to the delays while seeking those services thus poor quality care. As a result, service utilization will be negatively impacted due to poor quality of care(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Therefore, there is a need to decentralize cervical cancer screening services and adopt and encourage self-cervical cancer screening in low-resource settings. This will help decongest the main screening centres and improve accessibility.\u003c/p\u003e \u003cp\u003eTo enhance the usage of cervical cancer screening services among HIV-positive women, participants were provided with an opportunity to propose effective methods for the implementation of these services. This exercise aimed to gather valuable insights from individuals with relevant experience or knowledge, which could be utilized in designing and executing targeted interventions that could increase the uptake of cervical cancer screening among this specific population. They suggested that CCS can be improved through continuous health education on cervical cancer, community sensitization, and ensuring privacy for the women who go for screening services at the health facility. By considering the suggestions, it is hoped that healthcare providers and policymakers can create more tailored and effective strategies that address the unique challenges and barriers faced by HIV-positive women when accessing cervical cancer screening services.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eLike all qualitative studies, our study used a small sample size hence our findings may not be generalizable to larger settings but rather transferable to similar settings. Secondly, we did not include community healthcare providers who are nearer to the community and could have unique perceptions and practices.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and recommendations","content":"\u003cp\u003eHealthcare providers knew cervical cancer screening by HPV testing and Visual Inspection with Acetic acid and provided routine health education on screening, and cervical cancer screening to HIV-positive women. They perceived increased demand for CCS services by HIV-positive women, which is attributed to their increased awareness, the presence of signs and symptoms, and their desire to maintain optimal health. Despite several hindering factors, such as long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers, the practice of cervical cancer screening can be improved by reducing waiting times, increasing access to healthcare facilities, and ensuring that patients feel comfortable throughout the screening process.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to acknowledge the study participants who spared time to participate in the study. Additionally, we would like to thank our research assistants who collected this valuable data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of materials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant materials and methods concerning the study will be availed on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funding support or grant to conduct the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBruni L, Albero G, Serrano B, Mena M, G\u0026oacute;mez D, Mu\u0026ntilde;oz J et al (2019) ICO/IARC information centre on HPV and cancer (HPV information centre). 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Global health action 10(1):1380361\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoskun S, Can H, Turan S (2013) Knowledge about cervical cancer risk factors and pap smear testing behaviour among female primary health care workers: a study from south Turkey. Asian Pac J Cancer Prev 14(11):6389\u0026ndash;6392\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSait KH (2011) Knowledge, attitudes, and practices regarding cervical cancer screening among physicians in the Western Region of Saudi Arabia. Saudi Med J 32(11):1155\u0026ndash;1160\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdageba RK, Danso KA, Ankobea FK, Kolbilla DZ, Opoku P (2011) Knowledge of cervical cancer and patronage of cervical cancer screening services among female health workers in Kumasi, Ghana. 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Asian Pac J Cancer Prev 14(2):849\u0026ndash;852\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakayita RM, Benyumiza D, Nekesa C, Misuk I, Kyeswa J, Nalubuuka A et al (2023) Factors associated with uptake of human papillomavirus vaccine among school girls aged 9\u0026ndash;14 years in Lira City northern Uganda: a cross-sectional study. BMC Womens Health 23(1):362\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKisaakye E, Namakula J, Kihembo C, Kisakye A, Nsubuga P, Babirye JN (2018) Level and factors associated with uptake of human papillomavirus infection vaccine among female adolescents in Lira District, Uganda. Pan Afr Med J. ;31(1)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLayet F, Murungi T, Ashaba N, Kigongo E, Opollo MS (2024) Factors associated with utilization of cervical cancer screening services among HIV-positive women aged 18 to 49 years at Lira regional referral hospital, Northern Uganda. BMC Womens Health 24(1):114\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarah Maria N, Olwit C, Kaggwa MM, Nabirye RC, Ngabirano TD (2022) Cervical cancer screening among HIV-positive women in urban Uganda: a cross-sectional study. BMC Womens Health 22(1):148\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdikom CM, Ofi BA (2012) Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: a qualitative study. Reproductive Health 9(1):11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRitchie J, Lewis J, Nicholls CM, Ormston R (2013) Qualitative research practice: A guide for social science students. sage, and researchers\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObol JH, Lin S, Obwolo MJ, Harrison R, Richmond R (2021) Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda. BMC Cancer 21(1):110\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeena H, Durrani S, AlFayyad I, Riaz M, Tabasim R, Parvez G et al (2019) Knowledge, attitudes, and practices towards cervical cancer and screening amongst female healthcare professionals: a cross-sectional study. Journal of oncology. ;2019\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu SH, Woldehanna BT, Nida ET, Tilahun AW, Gebremariam MY, Sisay MM (2020) The role of health education on cervical cancer screening uptake at selected health centres in Addis Ababa. PLoS ONE 15(10):e0239580\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgide FD, Garmaroudi G, Sadeghi R, Shakibazadeh E, Yaseri M, Koricha ZB et al (2018) A systematic review of the effectiveness of health education interventions to increase cervical cancer screening uptake. Eur J Pub Health 28(6):1156\u0026ndash;1162\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdongo Ojok I, Ogwal JB, Wwesige B, Bongomin F, Akello F (2023) Factors Associated with the Human Papillomavirus Vaccine Coverage in Gulu District, Uganda. Adolesc Health Med Ther. :87\u0026ndash;96\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSam O (2022) Assessing Knowledge, Attitude, and Practices of Women of Reproductive Age (15\u0026ndash;49) Towards Cervical Cancer Screening in Adyel Division, Adyel Ward, Lira City West Division, Lira City. J Biomed Biosens 2(2):11\u0026ndash;30\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGwokyalya GB, Ayebazibwe A, Kinyera C, Nabanoba S, Pebalo FP (2022) Utilization of cervical cancer screening services and associated factors among HIV-positive women receiving care at an antiretroviral therapy clinic in Gulu Regional Referral Hospital\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherris J, Wittet S, Kleine A, Sellors J, Luciani S, Sankaranarayanan R et al (2009) Evidence-based, alternative cervical cancer screening approaches in low-resource settings. Int Perspect Sex reproductive health 35(3):147\u0026ndash;152\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMusa J, Achenbach CJ, O\u0026rsquo;Dwyer LC, Evans CT, McHugh M, Hou L et al (2017) Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis. PLoS ONE 12(9):e0183924\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlack E, Hyslop F, Richmond R (2019) Barriers and facilitators to uptake of cervical cancer screening among women in Uganda: a systematic review. BMC Womens Health 19(1):108\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbugu LI, Nwagu EN (2021) Awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria. Pan Afr Med J 39:200\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTavasoli SM, Pefoyo AJK, Hader J, Lee A, Kupets R (2016) Impact of invitation and reminder letters on cervical cancer screening participation rates in an organized screening program. Prev Med 88:230\u0026ndash;236\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThembekile Shato UN, Boakye EA, Fu QJ, Iwelunmor J (2023) Anne Sebert Kuhlmann. Uptake of cervical cancer screening services in urban Zimbabwe: Healthcare provider perspectives [abstract]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDriscoll SD (2016) Barriers and facilitators to cervical cancer screening in high incidence populations: A synthesis of qualitative evidence. Women Health 56(4):448\u0026ndash;467\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdejjo R, Mukama T, Kiguli J, Musoke D (2017) Knowledge, facilitators and barriers to cervical cancer screening among women in Uganda: a qualitative study. BMJ open 7(6):e016282\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi M, Nyabigambo A, Navvuga P, Nuwamanya E, Nuwasiima A, Kaganda P et al (2017) Acceptability of cervical cancer screening using visual inspection among women attending a childhood immunization clinic in Uganda. Papillomavirus Res 4:17\u0026ndash;21\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarris B, Goudge J, Ataguba JE, McIntyre D, Nxumalo N, Jikwana S et al (2011) Inequities in access to health care in South Africa. J Public Health Policy 32(Suppl 1):S102\u0026ndash;S123\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Lira University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knowledge, Practices, Perceptions, Healthcare providers, Cervical Cancer Screening","lastPublishedDoi":"10.21203/rs.3.rs-5000041/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5000041/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCervical cancer remains a global burden and is by far one of the major causes of premature death among women of reproductive age. We explored the knowledge, practices, and perceptions of healthcare providers on cervical cancer screening among HIV-positive women aged 18-49 years in Lira City.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn June 2023, a qualitative cross-sectional study was conducted among healthcare providers at Lira Regional Referral Hospital (LRRH), Lira City, Northern Uganda. Key informant interviews (KII’s) were used to collect data among purposively selected healthcare providers. Interviews were audio-recorded, transcribed verbatim and coded using the NVivo (QSR International) software. Thematic content analysis was used in data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe study found that participants had good knowledge about cervical cancer and screening. They provided health education, and vaccination for eligible girls and screened HIV-positive women for cervical cancer. Long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers were reported as barriers to CCS utilization. However, increased awareness, the presence of signs/symptoms, and the desire to maintain optimal health facilitated CCS utilisation among HIV-positive women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eHealthcare providers knew about cervical cancer screening by HPV testing and Visual Inspection with Acetic acid and provided routine health education on screening, and cervical cancer screening to HIV-positive women. They perceived increased demand for CCS services by HIV-positive women, which is attributed to their increased awareness, the presence of signs and symptoms, and their desire to maintain optimal health. Despite several hindering factors, such as long waiting hours, long distances to healthcare facilities, and negative attitudes of some health providers, the practice of cervical cancer screening can be improved by reducing waiting times, increasing access to healthcare facilities, and ensuring that patients feel comfortable throughout the screening process.\u003c/p\u003e","manuscriptTitle":"Knowledge, practices, and perceptions of the healthcare providers on cervical cancer screening among HIV-positive women at Lira Regional Referral Hospital, Lira City.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-02 09:30:44","doi":"10.21203/rs.3.rs-5000041/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc2a335b-b4f0-43a8-872f-4ea8c12852ca","owner":[],"postedDate":"September 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36810724,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2024-09-02T09:30:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-02 09:30:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5000041","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5000041","identity":"rs-5000041","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}