Factors Associated With Underutilization of Cervical Cancer Screening Services among HIV Positive Women in Serenje District, Central Province

Abstract

Cervical cancer is the most common cancer among women living with Human Immunodeficiency Virus (HIV) (UNAIDS, 201959). An estimated 604,000 new cases were diagnosed globally, with 342,000 deaths recorded in 2020 (Sung et al., 202169). According to WHO (2020), approximately 6.5% of all female cancers are cervical cancer-related, with 5% of cases attributable to HIV. Zambia ranks second in cervical cancer incidence, with an estimated mortality of 1,839 (WHO, 202056). The current utilization of cervical cancer screening services (CCSS) in Zambia among HIV-positive women stands at 27%, indicating underutilization (UNAIDS, 201959). In Serenje District, only 25.8% of HIV-positive women access these services. This study determined factors associated with the underutilization of CCSS among HIV-positive women in Serenje District.
Methods
A descriptive cross-sectional study was conducted involving 303 HIV-positive women in Serenje District of Central Province, Zambia. Systematic random sampling was used to recruit respondents from selected facilities, and a structured questionnaire was employed for data collection. Statistical Software (STATA V15) was utilized for analysis. Univariate, bivariate, and multivariable logistic regressions were performed to determine associations between variables.
Results
Utilization of CCSS in Serenje District was low, with only 42.24% of respondents reporting service use. Being far from a healthcare facility [AOR: 0.49 (P<0.036, 95% CI 0.25-0.96)], low/inadequate knowledge [AOR: 0.26 (P<0.001, 95% CI 0.13-0.54)], low income [AOR: 0.16 (P<0.001, 95% CI 0.06-0.37)], and negative attitudes towards CCSS [AOR: 0.26 (P<0.001, 95% CI 0.12-0.53)] were significant contributors to reduced utilization.
Conclusion
Low knowledge, poor attitudes, far distances to healthcare facilities, and poor socioeconomic status were identified as key factors contributing to the underutilization of CCSS. It is recommended that the district design and implement awareness campaign on cervical cancer screening services, engage in outreach awareness campaigns, and conducts screening camps to bring these services closer to the communities.