Predictors of uptake of cervical cancer screening among women living with HIV/AIDS in Kigali, Rwanda

Abstract

Cervical cancer (CC) remains a significant public health problem worldwide. The likelihood of cervical cancer has been shown to be associated with HPV, and people living with HIV are particularly affected. In Rwanda, the prevalence of HPV was almost four times higher among HIV-positive women (31.8% vs. 8.2%) than among HIV-negative women in Rwanda, indicating a high risk of cervical cancer. It is believed that the increased likelihood of cervical cancer screening (CCS) would have a significant impact on reducing the burden of disease. We therefore conducted this study to determine the predictors of cervical cancer screening uptake among women living with HIV in Kigali, thus providing information for the utilization of cervical cancer screening in Rwanda. This was a cross-sectional study design, evaluating the use of CCS among women living with HIV in the city of Kigali. This city has a high prevalence of HIV among women (6% vs. 2%) compared to other parts of the country. Proportionally, women aged 30-50 years followed in four health centers in the city of Kigali were selected by site. A questionnaire was administered to participants to determine the predictors of CCS use as an outcome. Predictors were socio-demographic and economic factors, factors related to individuals and health care institutions. For data analysis, using SPSS Version 24, frequency and percentage were used to present descriptions of study participants, bivariate and multivariate analysis to determine statistical significance and to highlight the strengths of associations. Variables with a P < 0.05 were considered statistically significant. Ethically, the study was approved by the Institutional Review Board of the Jomo Kenyatta University of Agriculture and Technology. Out of 384 participants, the prevalence of CCS uptake was 59%. A bivariate analysis revealed that two individual factors, such as age and religion, were statistically significant. For health-related factors, provider interviews with patients, distance to screening services, cost of services, lack of provider comfort, sources of information such as radio, posters, and television were found to be statistically significant. In the multivariate analysis, marital status, such as being single, and university education were the positive individual predictors of cervical cancer screening. At the health facility level, information sources such as radio were considered a positive predictor of cervical cancer screening uptake. Cervical cancer screening uptake in the city of Kigali was moderately good. There is a need to increase the number of screenings in order to gradually avoid this burden of cancer. Interventions targeting the education of women, especially those who are not yet married, and information disseminated by radio would add value to the use of screening in the city of Kigali.