Integrating cervical cancer screening with HIV care in a district hospital in Abuja, Nigeria

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From: Nigerian Medical Journal(Vol. 54, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 6,117 words
Lexile Measure: 1930L

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Byline: Solomon. Odafe, Kwasi. Torpey, Hadiza. Khamofu, Edward. Oladele, Oluwasanmi. Adedokun, Otto. Chabikuli, Halima. Mukaddas, Yelwa. Usman, Bolatito. Aiyenigba, MacPaul. Okoye

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. Materials and Methods: A cross-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.

Introduction

In sub-Saharan Africa, women account for about 60% of people living with human immunodeficiency virus (HIV) [sup][1] , and young women aged 15-24 years are as much as eight times more likely than men to be HIV positive (HIV+). [sup][2] Cervical cancer is the second most common type of cancer amongst women worldwide. [sup][3] Human papilloma virus (HPV) is the primary etiologic agent of cervical cancer. [sup][4],[5] Globally, HPV types 16 and 18, both of which are vaccine-preventable types, contribute to more than 70% of all cervical cancer cases. [sup][6] HPV-16 and 18, also contribute between 41% and 67% of high-grade and 16-32% of low-grade cervical lesions. [sup][6] Transmission of HPV occurs primarily by sexual contact. [sup][4],[7],[8] Known predisposing factors for HPV infection and...

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Gale Document Number: GALE|A336775691