Table 1c.
Quantitative and mixed-method studies conducted in Eastern Africa.
| First author, year | Country | Study design | Study setting | Population | Age | Screening status | Type of screening | Patient-reported factors influencing women’s cervical cancer screening experience. The (+/−) signs indicate women’s perception of how these factors influenced their screening experience. | MMAT score |
|---|---|---|---|---|---|---|---|---|---|
| Assefa et al. (2019) | Ethiopia | Cross-sectional study | Three public health facilities providing both cervical cancer screening and assisted reproductive technology services in Hawassa, Ethiopia | 342 HIV-positive women | Mean age 33.4 year | 40.1% screened within previous five years | NR |
Personal no need for cervical cancer screening due to no symptoms (34.1%) (−), fear of test results (16.1%) (−), fear of painful examination (11.2%) (−), positive attitude towards cervical cancer and screening (+), knowledge about cervical cancer risk factors (+) Social partner or husband support (+) Structural do not know the place for cervical cancer screening (6.3%) (−), expensive (2%) (−) |
75% |
| Belete et al. (2015) | Ethiopia | Mixed methods | Public health institutions of HIV care in Addis Ababa, Ethiopia | 322 HIV-positive women for quantitative and 14 HIV-positive women for qualitative study | Mean age 35.7 years | 11.5% screened at least once | NR |
Personal being pregnant or in peripartum period (13.3%) (−), fear of test result (30.8%) (−), knowledge about risk factors and prevention of cervical cancer (+) Social information sources [media, (58.2%) and HCP (53.6%)] (+), partner acceptance (10%) (+), religious denial (10%) (−) Structural expensive cervical cancer screening (30%) (−), lack of female screeners (13.3%) (−), time consuming (35.8%) (−) |
75% |
| Erku et al. (2017) | Ethiopia | Cross-sectional study | ART clinic at University of Gondar Referral and Teaching Hospital, Ethiopia |
302 HIV-positive women | Mean age 33.7 year | 23.5% screened at least once | NR |
Personal comprehensive knowledge about cervical cancer screening (OR: 3.02) (+), perceived susceptibility of cervical cancer (OR: 2.85) (+), absence of symptoms (88.7%) (−), embarrassment (68.8%) (−), fear of test result (71%) (−), not prescribed by the doctor (32.9%) (−) Structural expensive cervical cancer screening (27.7%) (−), Screening center too far (37.7%) (−), time consuming (19%) (−) |
75% |
| Shiferaw et al. (2018) | Ethiopia | Mixed methods | Public (community) health centers in Addis Ababa, the capital city of Ethiopia | 581 HIV-positive women | 21–64 years, mean age 34.9 year | 10.8% screened at least once | NR |
Personal feeling healthy (36.5%) (−), never think of cervical cancer (23.9%) (−), lack of awareness about cervical cancer screening (9.6%) (−), embarrassing (5.5%) (−), fear of positive results (5.3%) (−), painful screening procedure (1.2%) (−) Social partner negative attitude toward cervical cancer screening (1.4%) (−), religion factors (0.9%) (−), HCP negative attitude (0.7%) (−), no appropriate care at health care facilities (6.2%) (−), HCP do not have good knowledge (1.4%) (−) Structural did not know where to get cervical cancer screening (20.1%) (−), expensive cervical cancer screening (5.7%) (−), no health facility in the catchment area (4.3%) (−) |
75% |
| Solomon et al. (2019) | Ethiopia | Cross-sectional study | Hospital based setting In Bishoftu town, East Shoa, Ethiopia | 475 HIV-positive women | 18–67 years, mean age 36.2 year | 24.8% screened at least once | VIA |
Personal fear of positive result (28%) (−), being symptomatic (33.1%) (+), perceived self-efficacy (OR: 1.24) (+), perceived threat of cervical cancer (OR: 1.08) (+), perceived net benefit (OR: 1.18) (+) Social information sources [HCP (81.2%), media printed and non-printed (15.9%), close relatives (2.9%)] (+), partner negative attitude toward cervical cancer screening (15%) (−), HCP advice on cervical cancer screening (64.4%) (+), relatives (family/friends) advice (2.5%) (+) |
100% |
| Njuguna et al. (2017) | Kenya | Mixed methods | Kenyatta National Hospital, Nairobi, Kenya | 387 HIV-positive women for quantitative study and 4 focus group discussions (each group = 6–8 HIV-positive women) | Inter Quartile Range of 36–44 years, median age 40 | 46.3% screened at least once | NR |
Personal quality of information on cervical cancer screening services above average (OR 5.4–8.9) (+), had previous experience with cervical cancer screening before attending clinic (OR: 2.9) (+), fear of pain or excessive bleeding (−), young age and male gender of the HCP conducting the cervical cancer screening (−) Social cervical cancer screening recommended by HCP (OR: 10) (+) Structural long waiting time (−) |
50% |
| Rositch et al. (2012) | Kenya | Descriptive cross-sectional study | Voluntary counseling and testing centers in Nairobi, Kenya | 268 HIV-positive women and 141 HIV-negative women | Inter Quartile Range of 24–34 years, median age 28 | 14% screened at least once | Pap test |
Personal cervical cancer screening being part of routine care (42%) (+), cervical cancer screening being part of research study (19%) (+), being symptomatic (bleeding and abdominal pain) (6%) (+), did not know what cervical cancer screening is/why needed (78%) (−), knowledge of Pap test (OR: 1.8) (+), knowledge of HPV (OR: 1.7) (+), previous experience with Pap test (OR: 1.9) (+) Structural expensive cervical cancer screening (2%) (−), did not know where to get screened (4%) (−) |
75% |
| Rosser et al. (2015) | Kenya | Cross-sectional study | Integrated HIV clinic in the Nyanza Province of Kenya | 106 HIV-positive women | 23–64 years, mean age 34.9 year | 15% screened at least once | NR |
Personal screening by a male provider (8%) (−) Structural not willing to get screened if they had to pay (48%) (−) |
75% |
| Chipfuwa and Gundani (2013) | Zimbabwe | Descriptive cross-sectional study | Bindura Provincial Hospital, Zimbabwe | 70 HIV-positive women | 19–49 years, mean age 35.7 year | NR | NR |
Personal lack of Knowledge about risk factors of cervical cancer (90%) (−), low of perception about being at risk of cervical cancer among HIV-positive women (74.3%) (−), awareness of cervical cancer scored below the average (97.2%) (−) Social information sources [media, friends and relatives (40.5%), nurses (35.1%), general practitioner (10.8%), counselor (8.1%) and gynecologist (5.4%)] (+), lack of health education by HCP at clinic (97.1%) (−) |
25% |
| Koneru et al. (2017) | Tanzania | Cross-sectional study | HIV clinics in Dar es Salaam, Tanzania | 399 HIV-positive women | ≥19 years | 9% screened at least once | NR |
Personal had not been informed about care and treatment of cervical cancer at clinic (65.7%) (−) Social information sources [media (47.4%), hospital staff (39.3%), friends and families (4.8%)] (+), Structural free cervical cancer screening (83.3%) (+), free cervical cancer treatment (77.8%) (+), time to travel to clinic > 120 min (18.8%) (−) |
100% |
| Wanyenze et al. (2017) | Uganda | Nationwide cross-sectional study | 245 public and private HIV clinics across the five geographical regions (Central, Northern, Eastern, Western, and Kampala) in Uganda | 5198 HIV-positive women | 15–49 years | 30.3% screened at least once | NR |
Personal lack of information on cervical cancer screening (29.6%) (−), had been told that procedure is painful (10.5%) (−), fear of receiving a cancer diagnosis (40.6%) (−), embarrassing (22.3%) (−), knowledgeable of cervical cancer screening (PR: 2.19) (+), low risk perception (PR: 1.52) (+) Structural lack of screening facilities 14% (−), know any place where cervical cancer screening is offered (PR: 6.47) (+), did not have time (25.5%) (−) |
100% |
ART anti-retroviral therapy, HCP healthcare provider, HIV human immunodeficiency virus, MMAT mixed methods appraisal tool, NR not reported, PR prevalence ratio, OR odds ratio, VIA visual inspection with acetic acid.