Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen

Rufaro Mapaona; Victor Williams; Normusa Musarapasi; Sharon Kibwana; Thokozani Maseko; Rhinos Chekenyere; Sidumo Gumbo; Phetsile Mdluli; Hugben Byarugaba; Dileepa Galagedera; Arnold Mafukidze; Alejandra Hurtado-de-Mendoza; Prajakta Adsul; Pido Bongomin; Christopher Loffredo; Xolisile Dlamini; Deus Bazira; Sylvia Ojoo; Samson Haumba

doi:10.1371/journal.pgph.0002760

Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen

PLOS Glob Public Health. 2024 Apr 16;4(4):e0002760. doi: 10.1371/journal.pgph.0002760. eCollection 2024.

Authors

Rufaro Mapaona¹, Victor Williams^{1

2}, Normusa Musarapasi¹, Sharon Kibwana³, Thokozani Maseko¹, Rhinos Chekenyere¹, Sidumo Gumbo¹, Phetsile Mdluli¹, Hugben Byarugaba¹, Dileepa Galagedera¹, Arnold Mafukidze¹, Alejandra Hurtado-de-Mendoza⁴, Prajakta Adsul⁵, Pido Bongomin¹, Christopher Loffredo⁴, Xolisile Dlamini⁶, Deus Bazira³, Sylvia Ojoo³, Samson Haumba^{1

3}

Affiliations

¹ Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini.
² Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America.
⁴ Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America.
⁵ University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America.
⁶ National Cancer Control Program, Ministry of Health, Mbabane, Eswatini.

Abstract

This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.

Copyright: © 2024 Mapaona et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The Support Eswatini Achieve and Sustain HIV Epidemic Control (SEASEC) Program is supported by the U.S President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (Co-operative Agreement No.:NU2GGH002294), implemented by Georgetown University in collaboration with the Government of the Kingdom of Eswatini. The funders had no role in the conceptualization of the study, study design, data collection and analysis, decision to publish and preparation of the manuscript.