Integration of HIV testing into cervical cancer screening requires overcoming commodity supply challenges

Integrating HIV testing into cervical cancer screening in Tanzania: an analysis of routine service delivery statistics.

Plotkin M, Besana GV, Yuma S, Kim YM, Kulindwa Y, Kabole F, Lu E, Giattas MR. BMC Womens Health 2014 Sept 30: 14:120: doi:10.1186/1472-6874-14-120

Background: While the lifetime risk of developing cervical cancer (CaCx) and acquiring HIV is high for women in Tanzania, most women have not tested for HIV in the past year and most have never been screened for CaCx. Good management of both diseases, which have a synergistic relationship, requires integrated screening, prevention, and treatment services. The aim of this analysis is to assess the acceptability, feasibility and effectiveness of integrating HIV testing into CaCx prevention services in Tanzania, so as to inform scale-up strategies.

Methods: We analysed 2010-2013 service delivery data from 21 government health facilities in four regions of the country, to examine integration of HIV testing within newly introduced CaCx screening and treatment services, located in the reproductive and child health (RCH) section of the facility. Analysis included the proportion of clients offered and accepting the HIV test, reasons why testing was not offered or was declined, and HIV status of CaCx screening clients.

Results: A total of 24 966 women were screened for CaCx; of these, approximately one-quarter (26%) were referred in from HIV care and treatment clinics. Among the women of unknown HIV status (n = 18 539), 60% were offered an HIV test. The proportion of women offered an HIV test varied over time, but showed a trend of decline as the program expanded. Unavailability of HIV test kits at the facility was the most common reason for a CaCx screening client not to be offered an HIV test (71% of 6 321 cases). Almost all women offered (94%) accepted testing, and 5% of those tested (582 women) learned for the first time that they were HIV-positive.

Conclusion: Integrating HIV testing into CaCx screening services was highly acceptable to clients and was an effective means of reaching HIV-positive women who did not know their status; effectiveness was limited, however, by shortages of HIV test kits at facilities. Integration of HIV testing into CaCx screening services should be prioritized in HIV-endemic settings, but more work is needed to eliminate logistical barriers. The coverage of CaCx screening among HIV care and treatment-enrolled women in Tanzania may be low and should be examined.

Abstract  Full-text [free] access

Editor’s notes: This study discusses the integration of HIV testing into cervical cancer screening services in government health facilities in Tanzania, over a period of four years. The authors examined the acceptability (expressed as the acceptance of the HIV test by clients) and effectiveness (expressed as the number and proportion of women being offered an HIV test) of this approach.

Almost all women accepted testing, some 94%, but among the women of unknown HIV status only 60% were offered an HIV test. Insufficient supply of HIV test kits at health facilities together with a shortage of health care providers was the biggest challenge, limiting the effectiveness of the programme.

Due to their increased risk of cervical cancer, women in HIV care should be accessing screening services. However, data from this study suggested that integration in this direction was not as effective. The proportion of women in HIV care and treatment centres screened for cervical cancer varied between three percent and 46%. 

This study also demonstrates that data collected routinely as part of service delivery can be valuable for research purposes, especially when steps have been taken to strengthen the health information management system.

HIV testing
Africa
United Republic of Tanzania
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