Patients' self-reported factors influencing cervical cancer screening uptake among HIV-positive women in low- and middle-income countries: An integrative review

Cervical cancer screening delay and associated factors among women with HIV in Lesotho: a mixed-methods study

BACKGROUND

Cervical cancer is the fourth most common cancer in women worldwide, and women with human immunodeficiency virus (HIV) are particularly at risk of developing it. Regular screening effectively prevents morbidity and mortality. This mixed-methods study quantitatively assessed cervical cancer screening uptake and qualitatively explored the process of undergoing cervical cancer screening to understand possible reasons for delayed screening among women with HIV in Lesotho.

METHODS

Between October 2020 and March 2022, the Viral load Triggered ART care in Lesotho (VITAL) trial enrolled women aged 18 years and older with HIV who were taking antiretroviral therapy (ART). Cervical cancer screening delay was defined as reporting a screening that occurred more than two years ago or never having been screened. Cervical cancer screening uptake and the association between screening delay and sociodemographic variables were assessed using a multivariable mixed-effects logistic regression model accounting for clustering at clinic level. In-depth interviews were conducted with 16 women to obtain information on awareness, perceptions, and barriers to cervical cancer screening and were analyzed using thematic analysis.

RESULTS

Quantitative data were available for 3790 women. Among them, cervical cancer screening was delayed in 1814 (47.9%), including 1533 (40.5%) who were never screened. Compared to women aged 25 to 39 years, women aged 18 to 24 years (adjusted odds ratio (aOR) 2.8; 95% confidence interval (CI) 2.1-3.7), women aged 40 to 59 years (aOR 1.3; CI 1.1-1.6), and women older than 60 years (aOR 3.9; CI 3.0-5.1) were at higher risk of screening delay. Furthermore, time on ART below 6 months (aOR 1.6; CI 1.1-2.3) compared to above 6 months was associated with screening delay. Qualitative data identified limited awareness of cervical cancer risks and screening guidelines, misconceptions and fears created by the influence of other women's narratives, and low internal motivation as the main barriers to screening uptake.

CONCLUSIONS

Cervical cancer screening delay was common. Limited personal awareness and motivation as well as the negative influence of other women were the primary internal barriers to cervical cancer screening. Awareness and screening campaigns in Lesotho should consider these factors.

TRIAL REGISTRATION

clinicaltrials.gov, NCT04527874, August 27, 2020.

Cervical Pap screening among women living with HIV in Puerto Rico and the United States - Medical Monitoring Project, 2018-2021

Our objective was to determine the prevalence of cervical Pap screening among women living with HIV (WLWH) in Puerto Rico (P.R.) and other selected United States (U.S.) jurisdictions. Additionally, we sought to compare selected characteristics of WLWH who underwent cervical Pap screening between P.R. and the other U.S. jurisdictions. We analyzed data from the 2018-2021 cycles of CDC's Medical Monitoring Project (MMP), a national surveillance system among adults with HIV residing in P.R. (n = 218) and 22 other MMP jurisdictions (n = 3,653). Weighted percentages and 95 % confidence intervals (CIs) for selected characteristics were estimated. Prevalence ratios with predicted marginal means were calculated. An estimated 91.6 % and 84.6 % of WLWH underwent cervical Pap screening in P.R. and the other 22 MMP jurisdictions, respectively (Prevalence Ratio = 1.08, 95% CI = 1.03-1.13). Among WLWH who underwent cervical Pap screening, those in P.R. were more likely to be 50+ years of age, have a household annual income below $20,000, engage in binge drinking, never smoke, and have Medicaid/other public insurance than those in the other 22 MMP jurisdictions (p < 0.05). No differences were found between P.R. and the other 22 MMP jurisdictions in the percentage reporting higher than the median HIV-stigma score, experiencing HIV health care discrimination, and having ≥ 1 sexual partner in the past 12 months. Although cervical Pap screening rates among WLWH were higher in P.R. than in the other 22 MMP jurisdictions, both surpass the Healthy People 2030 target. Future research should assess adherence and compliance with updated cervical cancer screening guidelines.

Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study

BACKGROUND

Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death.

OBJECTIVE

We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda.

METHODS

In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis.

RESULTS

The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake.

CONCLUSION

Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.

Barriers Associated with Adherence to Cervical Cancer Screening Among Women Living with HIV in Nkhatabay District, Malawi: A Mixed-Methods Study

Background

Cervical cancer (CC) incidence among Women Living with HIV (WLHIV) is high compared to the general population of women. As such, the Malawi National CC guideline recommends yearly screening among WLHIV. However, only 15.9% of WLHIV were screened nationally using Visual Inspection with Acetic Acid (VIA) by 2015 and there is no data regarding adherence and barriers to yearly screening. This study assessed adherence levels and associated barriers to yearly Cervical Cancer screening (CCS) among WLHIV.

Methods

A cross-sectional concurrent mixed-method study was conducted at Nkhatabay District Hospital (NBDH) and Chintheche Rural Hospital (CRH) in Malawi. A sample of 205 WLHIV participated in quantitative strand and in-depth interviews were conducted with 10 health care workers and 10 WLHIV. Quantitative data were analysed using STATA version 16. Pearson's chi-square test and Multivariate logistic regression analysis were performed. P value was set at 0.05. Qualitative data were analysed deductively following six steps of thematic analysis.

Results

Only 5.4% (n=11) of the participants had been screened as required. Women aged ≥45 had 4 times the odds of being screened for CC compared to ≤30 (OR 4.18, 95% CI 0.65-26.8). WLHIV on ART > 10 years had more than 5 times the odds of being screened (OR 5.9, 95% CI 1.08-33.19) compared with those on ART <3 years. Use of male service providers (p =< 0.001), fear of the VIA procedure (p = <0.001) and lack of interest (p = <0.015) were significant barriers to adherence. Qualitative findings revealed a lack of knowledge regarding CCS protocol and the use of male providers.

Conclusion

WLHIV face many challenges in accessing CCS and adherence to yearly CCS is very low. There is urgent need for targeted community awareness, scaling up of HPV tests and incorporation of CCS into routine integrated outreach services.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

Policy analysis of cervical cancer prevention in Iran based on the policy triangle model

BACKGROUND

Widespread use of screening in high-income countries has led to a significant reduction in cervical cancer mortality. Most low- and middle-income countries still have poorly organized screening programs. This study aimed at policy analysis of prevention and early detection of cervical cancer in Iran, a middle-income country.

MATERIALS AND METHOD

This qualitative retrospective study, extended by the health policy triangle model, was conducted from July 2020 to September 2021. A sample of this study consisted of 43 participants, including 16 key policy experts; nine 11 senior health system managers, 13 executives, and 3 clients selected purposefully. Data were collected through semi-structured interviews using the interview guide and analyzed using a framework analysis method based on the policy triangle model in MAXQDA2020.

RESULTS

Nine themes, 15 subthemes, and 36 codes were extracted based on the 4 dimensions of the model; stakeholder analysis challenges, including conflict of interest and decision-making challenges. Moreover, the most important policy process challenges indicated the weakness of monitoring and evaluation systems and weakness of using scientific principles in policy making. Weakness of organizational and intersectoral structure and weakness of executive management were obtained among the challenges in the context analysis. Finally, the most important challenges related to content analysis are weaknesses in applying scientific principles in policy making, including weaknesses in standard operating procedures, and low use of HTA capacity in developed guidelines.

CONCLUSION

A wide range of economic, social, and cultural problems can affect cervical cancer prevention policies. Several strategies are suggested to overcome these challenges, including allocating separate funds to cancer prevention programs, using structures to sustain prevention programs, designing, and using them to improve public awareness.

Cervical Cancer Prevention, Its Challenges and Solutions in Iran and Worldwide: A Systematic Review

Background

Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late diagnosis of cervical cancer was the failure to perform a Pap smear (Papanicolaou). We aimed to investigate the status of cervical cancer prevention and its challenges and solutions in Iran.

Method

We conducted a systematic review of literature published from 1974 to 2021 in the electronic databases, including PubMed, Web of Science, Embase, Scopus, and Google Scholar, and retrieved all English-language articles. Following the application of the inclusion and exclusion criteria, full-text articles were identified and evaluated for eligibility. Finally, these publications were analyzed as part of the synthesis.

Results

Lower social-economic level, inadequate knowledge of screening tests and health centers for Pap test performance leading to worse outcomes such as lower screening participation or coverage.

Conclusion

By addressing these challenges through increasing education, increasing service accessibility, expanding screening programs, improving public awareness, improving insurance coverage, and establishing a control protocol for follow-up, it is possible to reduce cervical cancer incidence and mortality.

The impact of social media on guideline-concordant cervical cancer-screening: insights from a national survey

OBJECTIVES

Cervical cancer is one of the leading causes of cancer mortality in women, yet routine screenings lead to early detection and sometimes even prevention. Screening is an effective way to prevent cervical cancer, and it has been implemented in many countries and regions worldwide, especially in developed countries. However, the incidence of cervical cancer remains a public health problem due to screening disparities in the population. Social media engagement and overloading of online health information may be the cause of this disparity.

STUDY DESIGN

Cross-sectional study.

METHODS

Data from the Health Information National Trends Survey (a national survey conducted by the National Cancer Institute) was used to characterise cervical cancer screening into two dimensions; namely, high-frequency screening and guideline-concordant screening. The differences between these two screening frequency behaviours were compared by applying ordered logistic regression and binary logistic regression, and the mechanisms of guideline-concordant screening were explored.

RESULTS

The factors influencing high-frequency screening and guideline-concordant screening were different. Only self-efficacy (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.98, 1.37) had a significant positive association with the high-frequency screening behaviour. Social media engagement (OR = 0.57; 95% CI = 0.33, 0.96) was shown to have a significant negative impact on guideline-concordant screening. A theory-based mechanism of screening behaviour found that traditional health perception factors no longer influence guideline-concordant screening behaviour, whereas environmental factors (e.g., social media) significantly reduce guideline-concordant screening behaviour.

CONCLUSIONS

The results from this study indicate that while the internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviours. Overloading of online health information and the digital divide may lead to excessive screening. Consequently, it is important to address the screening disparity caused by health behaviours as a result of environmental factors and the digital divide.

Factors Influencing the Experience of Breast and Cervical Cancer Screening Among Women in Low- and Middle-Income Countries: A Systematic Review

PURPOSE

The persistent high morbidity and mortality from breast and cervical cancer in low- and middle-income countries (LMICs) may be influenced by global disparities in the uptake of screening services. This review sought to synthesize existing evidence to determine factors that influence the experience of women relating to breast and cervical screening in LMICs.

METHODS

A qualitative systematic review of the literature identified through Global Health, Embase, PsycInfo, and MEDLINE. Eligible studies included those outlining primary qualitative research or mixed-method studies with reporting of qualitative findings, detailing women's experiences of involvement with programs for breast or cervical cancer screening. Framework synthesis was used to explore and organize findings from primary qualitative studies and the Critical Appraisal Skills Programme checklist used for quality assessment.

RESULTS

Database searches yielded 7,264 studies for title and abstract screening and 90 full-text articles for screening, with qualitative data from 17 studies and a total of 722 participants included in this review. Four stages influencing experiences of women were generated across both breast and cervical cancer screening approaches, with individual (eg, knowledge of cancer), social (eg, religion, cultural beliefs), and health system (eg, accessibility) factors identified that influence women's initial and subsequent engagement.

CONCLUSION

This study synthesizes existing evidence of factors that influence engagement with breast and cervical cancer screening in LMICs. Evidence-informed recommendations are proposed that may improve the experience of cancer screening in LMICs, with further research necessary to explore their operationalization and impact on cancer care delivery.

Cervical cancer in Northern Tanzania-What do women living with HIV know

Background

Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania.

Methods

This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) at KCMC. A pre-tested questionnaire was used to collect quantitative data. Both descriptive and regression methods were used to determine CC knowledge, awareness, and beliefs as well as factors associated with knowledge of CC among WLHIV using SPSS version 23.

Results

Participants' mean age was 46 ± 10.4 years. Although just half (54.7%) of WLHIV had insufficient knowledge of CC, the majority of the participants (83.5%) were able to recognize at least three risk factors, but with limited understanding of symptoms and prevention. The majority held positive beliefs on CC and screening practices. Factors associated with good knowledge of CC included being married (AOR: 3.66, 95% CI: 1.84-7.28), having used ART for at least 2 years (AOR: 4.08, 95% CI: 1.36-12.21), and having previously screened for CC (AOR: 1.62, 95% CI: 1.01-2.59).

Conclusion

WLHIV attending care and treatment center had insufficient knowledge about CC screening. To further improve screening and treatment for CC, at both facility and community levels, targeted awareness and education campaigns are warranted.

Factors associated with cervical cancer screening among women living with HIV in the Kilimanjaro region, northern Tanzania: A cross-sectional study

Despite cervical cancer being a highly preventable disease, it is the fourth most common cancer among women in both incidence and mortality. Cervical cancer screening is crucial in preventing the disease. Women living with HIV (WLHIV) are at higher risk of cervical cancer because of their immune-compromised state. We aimed to determine factors associated with cervical cancer screening among WLHIV in the Kilimanjaro region, northern Tanzania. A cross-sectional study was conducted in the Kilimanjaro region among 297 WLHIV attending care and treatment centers (CTC) in northern Tanzania between August 21 and September 3, 2020; and interviewed using a questionnaire. Logistic regression model determined factors associated with cervical cancer screening at 5% significance level. Half (50.2 %) of the 297 WLHIV had ever screened for cervical cancer. WLHIV with positive attitudes towards cervical cancer screening (AOR = 3.48, 95 % CI 1.86, 6.51) and those who received information on cervical cancer from Health Care Providers (HCP) (AOR = 17.31, 95 % CI 6.00, 50.22) had higher odds of ever being screened for cervical cancer. Lower odds of screening (AOR = 0.50, 95 % CI 0.27, 0.96) were among women diagnosed with HIV within the past three years. WLHIV having a positive attitude towards screening and received cervical cancer screening information from HCP, were likely to have ever screened. Women newly diagnosed with HIV are less likely to have ever screened. HCPs at CTC are an important source of information about screening and for promoting cervical cancer screening among WLHIV. Special attention should be given to women newly diagnosed with HIV.

Accuracy of HPV testing on self-collected and clinician-collected samples for different screening strategies in African settings: A systematic review and meta-analysis

OBJECTIVES

Cervical cancer still poses a considerable threat to women in low- and middle-income countries, particularly on the African continent. Self-collection of a vaginal sample promises advantages over the established sampling by clinicians. We aimed to assess the accuracy of self-sampling compared to clinician sampling in order to inform its application in primary care in the African context.

METHODS

We searched Pubmed, Livivo, Web of Science, Cochrane Library and African Index Medicus on the 07th of February 2022. The eligibility criteria were: reporting (i) self-sampling against clinician-sampling, (ii) study location in Africa, (iii) relevant outcome-measures: (a) Cohen's kappa (b) sensitivity and specificity of self-sampling tests. We combined Cohen's kappa effects, additionally sensitivity and specificity estimates using random-effects models. The study is registered with PROSPERO (CRD42020218081).

RESULTS

We included 28 studies in the systematic review and 21 studies in the meta-analysis. Self-sampling was used to test for high-risk HPV infections. Two studies additionally tested for low-risk HPV infections. The pooled Cohen's kappa was 0.66 (95%CI: 0.61-0.71). Populations at risk yielded 0.63 (95%CI: 0.56-0.71). Target amplification tests based on PCR performed best with a kappa of 0.68 (95%CI: 0.63-0.73) compared to isothermal mRNA tests, 0.61 (95%CI: 0.51-0.71). Point of care tests performed exceptionally well, 0.73 (95%CI: 0.67-0.80). Sensitivities are close to 80% and specificities close to 90% of self-sampling to detect high-risk HPV.

CONCLUSIONS

Self-sampling agrees moderately to substantially with clinician sampling in the African context. Point of care tests might be particularly suited for application in cervical cancer primary screening in low- and middle-income countries. Populations at risk should get special attention while using self-sampling. Screening protocols should be established.

Precancerous Lesion of the Cervix and Associated Factors Among Women of West Wollega, West Ethiopia, 2022

Background

Precancerous cervical lesion is an abnormality in the cells of the cervix that could eventually develop into cervical cancer. Cervical cancer is a public health problem that contributes to the death of women worldwide. In line with the high burden of the issue, the Ethiopian government had attempted to expand cervical cancer screening centers and recommendation of services to age-eligible as well as high-risk groups of women. Therefore, the study aimed to assess the prevalence of precancerous lesions of cervix cancer among women aged 30-49 years and associated factors in West Wollega.

Method

Facility-based analytic cross-sectional study design was conducted in selected hospitals of West Wollega from January 1- February 20, 2022, among 339 women. A face-to-face interview was conducted and the presence or absence of precancerous cervical lesion was tested by visual inspection with acetic acid. Data were analyzed by SPSS version 25. Variable with P-value <.25 in the bi-variable analysis were entered into multivariable logistic regression. Results with a P-value ≤ .05 at 95% confidence level were considered for statistical significance.

Result

The prevalence of precancerous cervical lesions was 27.4% (95% CI: 22.7%32.1%). The mean standard deviation of participants was 35.22 +6.32 years. More than half (63.4%) and 67.6% of them were regarded as having good knowledge and a favorable attitude towards precancerous cervical lesions respectively. History of menstrual irregularity had two folds higher odds of being diagnosed with the precancerous cervical lesion when compared with counterparts at, [AOR = 2.29(95% CI:1.29-4.04]. Women with a history of STI had 3.5 times higher odds of developing precancerous cervical lesion compared to women with no history of STI [AOR)=3.46(95% CI:1.94-6.18)], history of bleeding after sexual intercourse was 2.88 times more likely to have precancerous cervical lesion compared to those without it at [AOR=2.88(95% CI:1.43-5.78)]. Parity greater than or equal to five had 2.4 times higher odds of developing precancerous cervical lesions compared to women with parity less than five at [AOR=2.41(95% CI: 1.23-4.75)]. History of steroid use had 3.5 times higher odds of developing precancerous cervical lesion compared with opponents at [AOR=3.5(95% CI: 1.32-9.34) and women with an Unfavorable attitude towards screening for Cervical cancer screening, prevention, and control methods had 2.2 times higher odds of developing precancerous cervical lesion compared their counterpart at [AOR=2.15(95% CI: 1.21-3.83)].

Conclusion

The precancerous cervical lesions continue to be a significant public health concern in Ethiopia. It will remain a significant cause of death of women unless effective screening methods like VIA and vaccination against HPV are scaled up. Furthermore, having a history of menstrual irregularities, STI, bleeding after coitus, parity greater than ≥5, steroid use, and having an unfavorable attitude towards screening factors are significantly associated with the occurrence of the precancerous lesion. Therefore, effective prevention approaches have to consider these factors for the control of cervical cancer in the early phase of the lesion.

Knowledge, perception of HIV symptom severity and cervical cancer screening behaviour among women living with HIV in China

OBJECTIVE

This study aimed to examine the previous uptake of cervical cancer screening and intention to be screened and its associated factors among women living with HIV in China.

METHODS

We conducted a cross-sectional survey of 213 women living with HIV to collect information about cervical cancer screening behaviour, demographics, knowledge about cervical cancer and screening, and perception of HIV symptom severity.

RESULTS

Seventy-eight women living with HIV (36.6%) had undergone cervical cancer screening, and 83 (61.5%) of the nonscreened women had the intention to be screened in the future. Using multivariate analysis, women who had more knowledge about cervical cancer screening (OR = 2.373, 95% CI = 1.593-3.534, p = 0.000) and had at least one nongynecological symptom (OR = 0.446, 95% CI = 0.204-0.978, p = 0.044) were more likely to have received screening previously.

CONCLUSION

This study emphasised that knowledge, as a salient factor, was crucial to promoting cervical cancer screening behaviour among women living with HIV. Effective measures should be taken to promote the knowledge about cervical cancer prevention. A new healthcare model, including preventive healthcare in addition to HIV/AIDS care, may be needed to address the complex needs of women living with HIV in China.

Designing DNA probe from HPV 18 and 58 in the E6 region for sensing element in the development of genosensor-based gold nanoparticles

The E6 region has higher protuberant probability annealing than consensus probe focusing on another region in the human papillomavirus (HPV) genome in terms of detection and screening method. Here, we designed the first multiple virus single-stranded deoxyribonucleic acid (ssDNA) for multiple detections in an early phase of screening for cervical cancer in the E6 region and became a fundamental evolution of detection electrochemical HPV biosensor. Gene profiling of the virus ssDNA sequences has been carried by high-end bioinformatics tools such as GenBank, Basic Local Alignment Searching Tools (BLAST), and Clustal OMEGA in a row. The output from bioinformatics tools resulted in 100% of similarities between our virus ssDNA probe and HPV complete genome in the databases. The cross-validation between HPV genome and our designed virus ssDNA provided high specificity and selectivity during screening methods compared with Pap smear. The DNA probe for HPV 18, 5' COOH-GAT CCA GAA GGT ACA GAC GGG GAG GGC ACG 3', while 5'COOH-GGG CGC TGT GCA GTG TGT TGG AGA CCC CGA3' as DNA probe for HPV 58 designed with 66.77% guanine (G) and cytosine (C) content for both. Our virus ssDNA probe for the HPV biosensor promises high sensitivity, specificity, selectivity, repeatability, low fluid consumption, and will be useful in mini-size diagnostic devices for cervical cancer detection.

Knowledge, attitude and practice of cervical cancer screening among women infected with HIV in Africa: Systematic review and meta-analysis

BACKGROUND

To establish successful strategies and increasing the utilization of preventive services, there is a need to explore the extent to which the general female population is aware and use the service for cervical cancer-screening among women infected with HIV in Africa. Available evidences in this regard are controversial and non-conclusive on this potential issue and therefore, we estimated the pooled effect of the proportion of knowledge, attitude and practice of HIV infected African women towards cervical cancer screening to generate evidence for improved prevention strategies.

METHODS

We applied a systematic review and meta-analysis of studies conducted in Africa and reported the proportion of knowledge, attitude and practice towards cervical cancer screening. We searched electronic databases: PubMed/Medline, SCOPUS, ScienceDirect, Web of science, Cumulative Index of Nursing and allied Health Sciences (CINAHL) and Google scholar databases to retrieve papers published in English language till August 2020. We used random-effects model to estimate the pooled effect, and funnel plot to assess publication bias. The registration number of this review study protocol is CRD42020210879.

RESULTS

In this review, we included eight published papers comprising 2,186 participants. The estimated pooled proportion of knowledge of the participants was 43.0% (95%CI:23.0-64.0) while the pooled estimates of attitudes and practices were 38.0% (95%CI: 1.0-77.0) and 41.0% (95%CI: 4.0-77.0), respectively. The proportion of the outcome variables were extremely heterogeneous across the studies with I2> 98%).

CONCLUSION

The pooled estimates of knowledge, attitude and practice were lower than other middle income countries calls for further activities to enhance the uptake of the services and establish successful strategies.