Determinants of cervical cancer screening utilization among HIV-positive women, in public general hospitals of Central Zone, Tigray, Ethiopia, 2020: Case-control study

PLOS ONE RESEARCH ARTICLE Determinants of cervical cancer screening utilization among HIV-positive women, in public general hospitals of Central Zone, Tigray, Ethiopia, 2020: Case-control study Tsega Gebremichael Gebremeskel ID1*, Merkeb Zeray Gebretatios2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department ofEpidemiology and Biostatistics, College of Health Sciences, Aksum University, Aksum, Ethiopia, 2 Department of General Public Health, College of Health Sciences, Aksum University, Aksum, Ethiopia * Abstract OPEN ACCESS Citation: Gebremeskel TG, Gebretatios MZ (2023) Determinants of cervical cancer screening utilization among HIV-positive women, in public general hospitals of Central Zone, Tigray, Ethiopia, 2020: Case-control study. PLoS ONE 18(12): e0289042. https://doi.org/10.1371/journal. pone.0289042 Editor: Mirgissa Kaba Serbessa, Addis Ababa University School of Public Health, ETHIOPIA Introduction Cervical cancer is the second leading cause of cancer-related morbidity and mortality in Ethiopia. Evidence showes that, despite the magnitude and severity of cervical cancer, utilization of cervical cancer screening in the study area among HIV-positive women is low. Objective This study aimed to assess the determinants of cervical cancer screening utilizationamong HIV-positive women in general public hospitals in the central zone of Tigray, Ethiopia. Received: October 15, 2020 Method Accepted: July 11, 2023 This study was a facility-based unmatched case-control study conductedamong HIVinfected womenin public general hospitals in the central zone of Tigray. Cases were HIV infected women not screened for cervical cancer, and controls were HIV infected women screened for cervical cancer. A total of 800participants (400 cases and 400 controls) wereselected using systematic random sampling with a 1:1 case-to-control ratio.Data collection was done using a pre-tested interviewer-administered questionnaire and a medical record review.The determinants of cervical cancer screeningutilization were identified through binary logistic regression. Published: December 12, 2023 Copyright: © 2023 Gebremeskel, Gebretatios. 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. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This research project was funded by Aksum University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Result Significant determinants of cervical cancer screening utilization among HIV-infected women in the central zone of Tigray werebeing in the age group of 18–30 [AOR = 0.46, 95% CI = 0.22, 0.98], living in rural areas [AOR = 0.47, 95% CI = 0.26, 0.87], no formal education [AOR = 0.25, 95% CI = 0.14, 0.45] and primary education [AOR = 0.28, 95% CI = 0.16,0.49], not working outside the home [AOR = 0.21, 95% CI = 0.10, 0.44], poor knowledge about cervical cancer [AOR = 0.29, 95% CI = 0.19, 0.44], and about cervical cancer PLOS ONE | https://doi.org/10.1371/journal.pone.0289042 December 12, 2023 1 / 13 PLOS ONE Abbreviations: ART, Anti-Retroviral Treatment; HIV/AIDS, Human Immune Deficiency Virus/ Acquired Immune Deficiency Syndrome; HPV, Human Papilloma Virus; STI- Sexually Transmitted Infection; VIF-, Variance Inflation Facto; WHO, World Health Organization. Determinants of cervical cancer screening utilization among HIV positive women screening [AOR = 0.44, 95% CI = 0.28, 0.70], and unfavorable attitudes toward cervical cancer screening [AOR = 0.52, 95% CI = 0.34, 0.79]. Conclusion Being in the age group of 18–30, living in rural areas, lacking formal education or havingonly primary level education, not working outside of the home, having poor knowledge of cervical cancer and screening,and having unfavourable attitudestowards cervical cancer screeningare significant determinat factors in cervical cancer screening utilization among HIVinfected women in the central zone of Tigray, Ethiopia. Considering such factors during the design of policies and programs could enhance the utilization of cervical cancer screening in the region. Introduction Cervical cancer is a malignancy primarly caused by the human papillomavirus (HPV) a sexually transmitted infection (STI) [1–3]. Cervical cancer is a major public health problem worldwide. In 2018, approximately 569,847 new cases of cervical cancer were diagnosed worldwide, and approximately 311,365 deaths were attributed to cervical cancer in that same year [4]. The majority of thesenew cases and deaths occurred in low- and middle-income countries. In sub-Saharan Africa,cervical cancer accountsfor 22.2% of all cancers in women. It isalso the leading cause of death from cancer among women in the region [5,6]. Sub-Saharan Africa has a double burden of humanpapilloma virus (HPV) and HIV infection. The presence of the HIV acquired immune deficiency syndrome (AIDS) epidemic in the region raises the burden of cervical cancer to a serious level [6,7]. In East Africa, age-adjusted cervical cancer incidence and mortality rate per 100,000 women is 40.1 and 30, respectively [4]. In Ethiopia, cervical cancer ranks as the second leading cause of female cancer, with an ageadjusted incidence rate of 18.9 and a mortality rate of 15.3 per 100,000 women [4]. The prevalence of HIV/AIDS among women aged 15–49 is 1.2% [8]. This indicates that around 378,000 women over age 15 living with HIV in Ethiopia are at risk of developing cervical cancer [4], as HIV infected women are four to five times more likely to acquire persistent HPV infection that can cause cervical abnormalities and cervical cancer, andalso have a reduced capacity to clear HPV-infection as compared to HIV-negative women [9]. Unlike other gynecological cancers,cervical cancer is potentially preventable. With effective screening programs,the incidence, morbidity, and mortality of cervical cancer can be reduced [1,3,10–12]. Moreover, regular screening of HIV-positive women followed by immediate treatment to detect precancerous lesions can potentially prevent 80% of cervical cancer cases [13]. Even though cervical cancer is a significant risk for HIV-positive women,cervical cancer screening utilization among HIV-positive women in the Tigray region is very low compared to the national recommended coverage of 80% [12]. Various factorscan affect cervical cancer screeningutilization [14–17]. Little is known, however, about the determinants of cervical cancer screening-utilization among HIV-positive women. Previous studies [17,18] conducted in the country among HIV-positive womenhave useda cross-sectional study design, and have reported that cerv (...truncated)