dc.description.abstract |
To achieve the WHO cervical cancer elimination targets, countries globally must
achieve 70% cervical cancer screening (CCS) coverage. We evaluated CCS uptake
and predictors of screening positive at two public HIV care programs in western
Kenya.
METHODS From October 2007 to February 2019, data from the Family AIDS Care and
Education Services (FACES) and Academic Model Providing Access to Healthcare
(AMPATH) programs in western Kenya were analyzed. The study population
included women age 18-65 years enrolled in HIV care. Screening uptake was
calculated annually and overall, determining the proportion of eligible women
screened. Multivariate logistic regression assessed predictors of positive
screening outcomes.
RESULTS There were 57,298 women living with HIV (WLWHIV) eligible for CCS across
both programs during the study period. The mean age was 31.4 years (IQR, 25.9-
37.8), and 39% were on antiretroviral therapy (ART) at the first CCS-eligible
visit. Of all eligible women, 29.4% (95% CI, 29.1 to 29.8) underwent CCS during
the study period, 27.0% (95% CI, 26.5 to 27.4) in the AMPATH program, and
35.6% (95% CI, 34.9 to 36.4) in the FACES program. Annual screening uptake
varied greatly in both programs, with coverage as low as 1% of eligible WLWHIV
during specific years. Age at first screening, CD4 count within 90 days of
screening, current use of ART, and program (AMPATH v FACES) were each
statistically significant predictors of positive screening.
CONCLUSION CCS uptake at two large HIV care programs in Kenya fell short of the WHO’s 70%
screening target. Screening rates varied significantly on the basis of the
availability of funding specific to CCS, reflecting the limitations of vertical
funding programs. |
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