Exploring effective approaches of integrating cervical screening services into the normal routine care within HIV clinics: A qualitative study in a Ugandan community health facility.

Cervical cancer is the leading cause of gynaecologic cancer death in sub-Saharan Africa, with HIV being a high-risk factor for its’ development. Where HIV prevalence is high, interventions can ideally be delivered through a ‘one-stop shop’ approach addressing both conditions simultaneously. Whilst evidence supports the feasibility and significance of service integration, there is a paucity of literature on practical and sustainable approaches to implementation in resource-constrained settings.  

Evaluation of the cervical cancer project in the facility under study found only 31.3% of eligible women utilising HIV services had been screened in August 2019. Furthermore, just 18.6% of those screened returned for an annual appointment – on average 9 months later than scheduled. 

My study thus sought to explore how to effectively integrate cervical screening into the normal routine HIV care services of this health facility, and as such, optimise screening coverage and timely follow-up amongst HIV positive women in care. 

It took a qualitative approach comprising of in-depth interviews with ten health care providers. The data was coded in NVivo 12 and analysed thematically.  

Four themes emerged from the interviews: views on the current cervical screening service provision, the perceived benefits and challenges of integrated HIV and screening services, health education and ‘expert clients’ and screening follow-up mechanisms. 

Overall, this study has confirmed the feasibility and significance of integrating cervical screening into HIV care and has synthesized practical and sustainable approaches to implementation in resource-constrained settings. 

Project Team: Dr Judith Auma, Prof Lisa Scullion, Dr. Eileen Cunningham 

Research Group: CSHR, Knowledge Health and Place, Msc by Research Projects 

Project Funder: The Royal Society of Tropical Medicine and Hygiene, Knowledge for Change