Barriers and facilitators on cervical cancer screening among HIV women in Cote d’Ivoire

• Published in: European journal of public health Vol. 29; no. Supplement_4
• Main Authors: Mensah, K, Pourette, D, Duschene, V, DeBeaudrap, P, Dumont, A
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2019; Oxford Publishing Limited (England); Oxford University Press (OUP): Policy B - Oxford Open Option D
• Subjects: Acetic acid; Cancer; Cancer screening; Caregivers; Cervical cancer; Death & dying; Empowerment; Fear; Health care facilities; HIV; Human health and pathology; Human immunodeficiency virus; Human papillomavirus; Infectious diseases; Inspection; Life Sciences; Medical screening; Public health; Sampling; Sampling methods; Santé publique et épidémiologie; Stigma; Strategy; Viruses; Women; Womens health; COTE D'IVOIRE
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckz185.055

Abstract Background With 50,000 death every year, cervical cancer is the fourth most common cause of death by cancer in sub-Saharan countries. Due to high risk human papilloma virus (hr-HPV) persistence on the cervix, leading to pre-malignous lesions, the disease is more frequent among HIV-positive women. In low- and middle-income countries, cervical cancer screening strategy relies on visual inspection with acetic acid, an operator-associated technic. As an alternative, HPV-based detection and its better performances are considered as it could lead to a potential screening uptake and women empowerment through self-sampling. Côte d’Ivoire, with a high HIV prevalence, is considering this innovative strategy. Yet, few studies analyzed the potential socio-cultural factors associated with cervical cancer screening in this context. Our study aims to assess beliefs and perceptions toward cervical cancer among HIV positive women in Abidjan, Côte d’Ivoire. Methods We performed in-depth interviews with 21 HIV positive women randomly attending a health center or member of a women’s association, in November 2018. All interviews were recorded and transcribed. A theoretical framework with the Health Belief Model and the PEN-3 was used to categorize women’s perceptions, enablers, nurturers, perceived gravity and self-efficacy about cervical cancer, screening and self-sampling technique introduction. Results Positive findings were knowledge about cervical cancer, awareness about women’s vulnerability and HIV status role on it and relationship to caregivers. Fear appeared as a barrier to screening but also a facilitator among women with health awareness. Negative findings were reluctance for HIV-associated diseases, poor screening knowledge and lack of resources to get treated. Self-sampling introduction was disregarded due to lack of self-confidence. Conclusions This study provides useful information for counselling and opens the door to HPV-based screening implementation. Key messages Beliefs and perceptions about cervical cancer screening among HIV women need to be assess before implementing a new strategy. Cervical cancer screening uptake will need to address fear, self-confidence and stigma.