Geographic and individual correlates of cervical cancer screening among HIV-infected women attending HIV Care and Treatment Programs in Kenya

Abstract

Objective: To identify correlates of cervical cancer screening among HIV-infected women in Kenya and to determine whether familiarity and knowledge of cervical cancer is associated with screening receipt. Methods: We conducted a sub-analysis from a cross-sectional study of HIV-infected women attending large HIV Care and Treatment programs across Kenya. 3,007 HIV-infected women attending ART treatment and who were eligible for cervical cancer screening services were included. We examined demographic, clinical, and geographic correlates of cervical cancer screening and their association to the outcomes of historical and up to date screening receipt. We assessed descriptive statistics of knowledge and familiarity with cervical cancer screening and association with screening outcomes. Results: 1,671 (56%) women reported ever being screened. Among women screened, 804 (48%) received screening services within the past 12 months and were classified as having up to date screening. Prevalence of screening was highest among women who were older (APR comparing age 35-49 to 18-24: 2.26, 95% CI: 1.68, 3.05), employed (APR: 1.55, 95% CI: 1.24, 1.93), married (APR: 1.27, 95% CI: 1.01, 1.59), had a secondary education or higher (APR: 1.45, 95% CI: 1.19, 1.77), and had been diagnosed with HIV for longer (APR: 1.09/year average increase, 95% CI: 1.04, 1.13). Women who were younger (APR comparing age 25-34 to 18-24: 0.58, 95% CI: 0.38, 0.87; APR comparing age 35-49 to 18-24: 0.41, 95% CI: 0.27, 0.64) and employed (APR: 1.83, 95% CI: 1.32, 2.55) were most likely to have up to date screening. Women with a history of screening were approximately twice as likely to correctly answer questions about cervical cancer (45-79%) as women who had never been screened (25-47%). Only 36% of women knew cervical cancer is treatable. Conclusions: Kenyan women attending HIV Care and Treatment Programs may be more likely than the general population to receive cervical cancer screening. Characteristics linked to empowerment and social or economic capital were correlated with higher cervical cancer screening rates. Accurate knowledge of cervical cancer is associated with screening history, but knowledge of cancer treatment is lacking. Integrating cervical cancer services into HIV care can increase opportunities for screening and treatment among women attending ART clinics who may be less likely to access cervical cancer screening.