Abstract
Background
Consistent with WHO guidance Zimbabwe is transitioning from annual single visit screen-and-treat using visual inspection with acetic acid and cervicography (VIAC) to HPV testing every three years to screen women living with HIV (WLHIV) for cervical cancer.Methods
We administered a questionnaire at three public-sector facilities in Zimbabwe to understand reasons why WLHIV accept or decline VIAC and preferences for implementation of HPV testing.Results
A total of 451 WLHIV completed the questionnaire, of whom 414 (91.8%) accepted VIAC screening and 37 (8.2%) declined screening. Close to 50% of the 37 women who declined screening indicated a preference for HPV testing. The majority of WLHIV (76.3%) had known their HIV positive status for ≥ 5 years and nearly all (99.8%) were on antiretroviral therapy. Among the 414 WLHIV accepting VIAC screening, 323 (78.0%) were re-screening, and 91 (22.2%) were screening for the first time. WLHIV accepting VIAC re-screening were motivated by healthcare workers helping them feel secure about their health (45.8%), compliance with annual screening recommendations (39.6%), and encouragement from a healthcare worker (8.0%). Those accepting VIAC screening for the first time were motivated by encouragement from a healthcare worker (39.6%), compliance with annual screening recommendations (38.5%), and helping them feel secure about their health (17.6%). When asked what screening approach they would prefer in the future, the majority of women accepting re-screening (70.3%) and first-time screeners (89%) indicated a preference for continuing with VIAC screening. The 93 WLHIV with a screening history who indicated a preference for HPV testing were evenly split between preferring provider-collected sampling (13.9%) and self-collected sampling at the health facility (13.6%). Fear of physical discomfort of a pelvic exam (54.1%), worry about the screening result (13.5%), and perceived side effects of VIAC (10.8%) were the most common reasons given by the 37 WLHIV who declined VIAC.Conclusions
Facilities transitioning to HPV testing will need to incorporate client-centered education that acknowledges existing individual commitment to VIAC, explains the benefits of HPV testing, and offers HPV self-sampling for WLHIV who are hesitant to undergo a pelvic exam.