Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa

Objectives Despite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer sc...

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Main Authors: Eugene Messou, Didier K Ekouevi, Boris Tchounga, Simon Pierre Boni, Jean Jacques Koffi, Apollinaire G Horo, Aristophane Tanon, Serge-Olivier Koulé, Innocent Adoubi, Antoine Jaquet
Format: Article
Language:English
Published: BMJ Publishing Group 2019-08-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/9/8/e029882.full
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author Eugene Messou
Didier K Ekouevi
Boris Tchounga
Simon Pierre Boni
Jean Jacques Koffi
Apollinaire G Horo
Aristophane Tanon
Serge-Olivier Koulé
Innocent Adoubi
Antoine Jaquet
author_facet Eugene Messou
Didier K Ekouevi
Boris Tchounga
Simon Pierre Boni
Jean Jacques Koffi
Apollinaire G Horo
Aristophane Tanon
Serge-Olivier Koulé
Innocent Adoubi
Antoine Jaquet
author_sort Eugene Messou
collection DOAJ
description Objectives Despite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d’Ivoire.Design Cross-sectional survey conducted from May to August 2017.Settings Outpatient setting in the four highest volume urban HIV clinics of government’s or non-governmental organisation’s sector in Côte d’Ivoire.Participants All WLHIV, aged 25–55 years, followed since at least 1 year, selected through a systematic sampling procedure.Intervention A standardised questionnaire administered to each participant by trained healthcare workers.Outcome Cervical cancer screening uptake.Results A total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37–47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, p<0.001), being informed on cervical cancer at the HIV clinic (aOR 1.5; 95% CI 1.1 to 2.0, p=0.017), receiving information self-perceived as ‘clear and understood’ on cervical cancer (aOR 1.7; 95% CI 1.4 to 2.2, p<0.001), identifying HIV as a risk factor for cervical cancer (aOR 1.4; 95% CI 1.1 to 1.8, p=0.002) and being proposed cervical cancer screening in the HIV clinic (aOR 10.1; 95% CI 7.6 to 13.5, p<0.001), were associated with cervical cancer screening uptake.Conclusion Initiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.
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spelling doaj-art-9cf724cd28bd49099a3028ee3d2866912025-08-20T02:07:41ZengBMJ Publishing GroupBMJ Open2044-60552019-08-019810.1136/bmjopen-2019-029882Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West AfricaEugene Messou0Didier K Ekouevi1Boris Tchounga2Simon Pierre Boni3Jean Jacques Koffi4Apollinaire G Horo5Aristophane Tanon6Serge-Olivier Koulé7Innocent Adoubi8Antoine Jaquet96 Centre de Prise en Charge de Recherche et de Formation CEPREF, Abidjan, Côte d`Ivoire9 Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lome, Togo1 Research, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon3 Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d`Ivoire1 Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d`Ivoire4 Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Lagune, Côte d`Ivoire5 Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d`Ivoire7 Unité de soins ambulatoires et de conseils d’Abidjan, USAC, Abdjan, Côte d`Ivoire3 Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d`Ivoire6 National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, FranceObjectives Despite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d’Ivoire.Design Cross-sectional survey conducted from May to August 2017.Settings Outpatient setting in the four highest volume urban HIV clinics of government’s or non-governmental organisation’s sector in Côte d’Ivoire.Participants All WLHIV, aged 25–55 years, followed since at least 1 year, selected through a systematic sampling procedure.Intervention A standardised questionnaire administered to each participant by trained healthcare workers.Outcome Cervical cancer screening uptake.Results A total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37–47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, p<0.001), being informed on cervical cancer at the HIV clinic (aOR 1.5; 95% CI 1.1 to 2.0, p=0.017), receiving information self-perceived as ‘clear and understood’ on cervical cancer (aOR 1.7; 95% CI 1.4 to 2.2, p<0.001), identifying HIV as a risk factor for cervical cancer (aOR 1.4; 95% CI 1.1 to 1.8, p=0.002) and being proposed cervical cancer screening in the HIV clinic (aOR 10.1; 95% CI 7.6 to 13.5, p<0.001), were associated with cervical cancer screening uptake.Conclusion Initiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.https://bmjopen.bmj.com/content/9/8/e029882.full
spellingShingle Eugene Messou
Didier K Ekouevi
Boris Tchounga
Simon Pierre Boni
Jean Jacques Koffi
Apollinaire G Horo
Aristophane Tanon
Serge-Olivier Koulé
Innocent Adoubi
Antoine Jaquet
Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
BMJ Open
title Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
title_full Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
title_fullStr Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
title_full_unstemmed Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
title_short Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d’Ivoire, West Africa
title_sort cervical cancer screening uptake and correlates among hiv infected women a cross sectional survey in cote d ivoire west africa
url https://bmjopen.bmj.com/content/9/8/e029882.full
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