Predictors of late presentation of cervical cancer in HIV-positive Ugandan women

Abstract

Predictors of late stage presentation of cervical cancer in HIV-positive Ugandan women Background Cervical cancer is one of the leading causes of cancer deaths in women globally and it is the number one cause of cancer morbidity and mortality in Ugandan women. No data on predictors of late stage cervical cancer in HIV-positive women presenting for oncologic care in Uganda is available. It is also not known how HIV care providers in Uganda view integration of cervical cancer screening in routine HIV care. Methods This was a cross sectional study of HIV-positive women with cervical cancer. Data were collected on demographics, HIV history, including CD4+ T-cell count, and cervical cancer history and stage. In addition, focus group discussions were held with staff in HIV clinics. Results Forty women completed study procedures, with a median age of 40 years (range 25 - 68). Thirty-two (40%) had late stage cervical cancer (FIGO stage III and IV). In bivariate analysis, there was an association between young age at sexual debut (16 years and younger) and presentation with late stage cervical cancer (OR = 0.273, p = 0.043). Having 2 or more lifetime sexual partners was also associated with 80% increased odds (OR=1.800, p=0.045). Importantly, CD4+ T-cell count were not associated with late stage cervical cancer. Qualitative data showed that HIV care staffs know that HIV-positive women are at high risk of cervical cancer, there is lack of awareness among the HIV- positive women and some of the key reasons why cervical cancer screening is not done routinely in HIV care are absence of a policy and HIV care guidelines that integrate the intervention. Conclusions Many HIV-positive women present with late stage cervical cancer. Women with low SES (poor, low education) with early sexual debut and multiple sexual partners were more likely to present