Understanding Barriers to Cervical Cancer Screening in Botswana: Insights From a Cross-Sectional Study [ID 3911]

INTRODUCTION: Cervical cancer (CxCa) is the leading cause of cancer deaths among women in Botswana, yet uptake of CxCa screening remains low. Understanding barriers to screening and gaps in CxCa awareness is essential to achieving the World Health Organization elimination targets. METHODS: We conducted a cross-sectional study of 3,000 women in South-East District, Botswana, between February 2022 and July 2023. Participants were 25 or older, with intact uteri and no prior CxCa diagnosis. After high-risk human papillomavirus (hrHPV) self-collection and laboratory testing, we administered structured questionnaires covering demographics, prior screening, CxCa knowledge, and barriers to screening. RESULTS: Overall, 49.8% of participants were women living with HIV (WLHIV); 56.0% of WLHIV versus 44.9% of HIV-negative women tested hrHPV-positive (adjusted odds ratio 1.79; 95% CI, 1.52–2.10). Only 27.1% correctly identified HPV as the cause of CxCa. Awareness of the HPV vaccine was low at 16%, and 67.2% of our cohort reported prior screening for CxCa. Among the 983 (32.8%) women who had never screened, the most common barriers were lack of prioritization (38.6%), fear of the procedure (15.8%), lack of information (9.3%), and lack of opportunity to screen (9.3%). Women living with HIV were significantly more likely to have ever screened (80.0% versus 54.5%, P <.001). CONCLUSIONS/IMPLICATIONS: Prior CxCa screening attendance, knowledge of HPV, and vaccination remain low, particularly in women without HIV, with patient-level factors being the most frequent barriers limiting screening attendance. Interventions that emphasize education, address fear, and expand access to self-sampling may strengthen engagement with screening programs and accelerate progress toward CxCa elimination in Botswana.