Barriers and facilitators of adherence to cervical cancer screening follow-up among women living with HIV in South Ethiopia: a qualitative study.

Abstract

BACKGROUND: Women living with human immune deficiency (WLWH) had higher risk of developing cervical cancer. Recurrence of the lesions is higher among WLWH than HIV negative women. Effective follow-up is very crucial in order to reduce the persistence of the lesions and avoid recurrence. However, less than half of the women attend yearly follow up in Ethiopia. This study investigated the barriers and facilitators of screening follow-up from the perspectives of WLWH and healthcare providers. OBJECTIVES: To explore the barriers and facilitators of cervical cancer screening follow-up among WLWH who were treated for pre-cancer lesions in the West Arsi Zone, South Ethiopia. METHODS: A descriptive qualitative study was conducted among 18 participants (12 WLWH and 6 healthcare providers) in two hospitals and two health centers in West Arsi Zone from January 1 to February 28, 2025. Participants were selected via purposive sampling technique. Data were collected using a semi-structured in-depth interview guide. ATLAS.ti version 25.0.1 was used for data analysis. Data were transcribed, translated verbatim and analyzed using thematic analysis, guided by the Social Ecological Model (SEM). Findings were reported using texts and quotations in line with the SEM framework. RESULTS: The major barriers were lack of awareness, fear, lack of money, poor counseling, gender preference, lack of privacy, stigma, traditional medicine and religious practices. On the other hand, having awareness, phone reminders, male partner support, good provider approach, free services and availability of alternative treatment options were identified as facilitators of follow-up. CONCLUSION: There are unique challenges facing WLWH cervical cancer screening adherence in Ethiopia. Ensuring compassionate and respectful care with availability of more female providers is crucial. Continuous awareness creation campaigns, empowering women, involving male partners, and promoting human papilloma virus (HPV) self-test could avert most of the identified barriers.