Women diagnosed with HIV and unknown HIV status perceived susceptibility to cervical cancer and perceived benefits of cervical cancer screening in Ghana: a cross-sectional study

HIV status and knowledge of cervical cancer among women in Ghana

BACKGROUND

Cervical cancer remains a disease of significant concern to women's health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH).

METHODS

This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis.

RESULTS

The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education.

CONCLUSIONS

To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed.

HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening

INTRODUCTION

Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV.

OBJECTIVES

This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana.

METHODS

Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana.

RESULTS

Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive).

CONCLUSIONS

There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.