Integrating cervical cancer screening with HIV care in a district hospital in Abuja, Nigeria
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Date
2013
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Publisher
Nigerian Medical Journal
Abstract
Background: Human immunodeficiency virus positive (HIV+) women have a higher
risk of developing invasive cervical cancer compared with uninfected women. This study
aims to document programmatic experience of integrating cervical cancer screening
using Visual Inspection and Acetic Acid (VIA) into HIV care as well as to describe
patients’ characteristics associated with positive VIA findings amongst HIV+ women.
Materialsand Methods:Across‑sectional study analysed routine service data collected at the
antiretroviral therapy (ART) and cervical cancer screening services. Our program integrated
screening for cervical cancer using VIA technique to HIV care and treatment services through
a combination of stakeholder engagement, capacity building for health workers, creating
a bi‑directional referral between HIV and reproductive health (RH) services and provider
initiated counselling and screening for cervical cancer. Information on patients’ baseline
and clinical characteristics were captured using an electronic medical records system and
then exported to Statistical Package for the Social Sciences (SPSS). Logistic regression model
was used to estimate factors that influence VIA results. Results: A total of 834 HIV+ women
were offered VIA screening between April 2010 and April 2011, and 805 (96.5%) accepted it.
Complete data was available for 802 (96.2%) women. The mean age at screening and first sexual
contact were 32.0 (SD 6.6) and 18.8 (SD 3.5) years, respectively. VIA was positive in 52 (6.5%)
women while 199 (24.8%) had a sexually transmitted infection (STI). Of the 199 who had a
STI, eight (4.0%) had genital ulcer syndrome, 30 (15.1%) had lower abdominal pain syndrome
and 161 (80.9%) had vaginal discharge syndrome. Presence of lower abdominal pain syndrome
was found to be a significant predictor of a positive VIA result (P = 0.001). Women with lower
abdominal pain syndrome appeared to be more likely (OR 47.9, 95% CI: 4.8‑480.4, P = 0.001)
to have a positive VIA result. Conclusion: The high burden of both HIV and cervical cancer
in developing countries makes it a necessity for integrating services that offer early detection
and treatment for both diseases. The findings from our study suggest that integrating VIA
screening into the package of care offered to HIV+ women is feasible and acceptable.
Description
Research Article
Keywords
Cervical cancer screening, human immunodeficiency virus, integration, Nigeria