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 premalignous 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 (VIA), an operator-dependent technic. Alternatives, using HPV-based detection through self-sampling are promising as it could increase women participation in screening and empowerment. Ivory Cost is part of a multi-country study on HPV Xpert assay-based screening among HIV-infected women (AIMA-CC project). Yet, few studies analysed 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.
Methods: We performed 21 in-depth interviews with two groups of HIV positive women: randomly attending a health center or member of a women association, in November 2018. All interviews were transcribed. Both Health Belief Model and PEN-3 Model were used as theoretical framework to categorize women’s perceptions, enablers, nurturers, perceived gravity, perceived benefits and self-efficacy about cervical cancer, cervical screening and self-sampling technique introduction.
Results: Facilitators to HPV testing were knowledge about cervical cancer, awareness about women’s vulnerability and HIV status role on it. Fear appeared to be a barrier to screening but also a facilitator among women with health awareness. Barriers to screening included lack of interest for HIV-associated health conditions, poor knowledge about screening and lack of resources to get treated. Self-sampling was considered as of interest, but most women would rather rely on health care providers to perform the sampling for HPV test. Conclusions: This study provides useful information for counselling and opens the door to HPV-based screening implementation
