Cervical cancer screening among HIV-positive women in conflict-affected and resource limited settings: the case of Tigray region, Ethiopia

BACKGROUND: Cervical cancer remains a significant public health concern, particularly among women living with HIV/AIDS, who are at increased risk due to compromised immunity. Despite the high burden of cervical cancer in sub-Saharan Africa, including Tigray, Ethiopia, the magnitude of cervical lesions within screening programs and its associated determinants remain inadequately addressed. This study assesses the magnitude and risk factors of precancerous cervical lesion among HIV-infected women in conflict-prone and resource- limited settings of Tigray, Ethiopia. METHODS: We conducted a facility-based cross-sectional study involving 2004 women attending antiretroviral therapy clinics. As part of the routine standard of care for cervical cancer screening in Ethiopia, participants underwent Visual Inspection with 5% Acetic Acid (VIA) at five sites of Mekelle public health institutions between June, 21, 2023, to May 30, 2024. Data were collected through structured interviews using Kobo toolbox and analyzed using SPSS version 23 with the use of logistic regression to examine associations between VIA positivity, demographics, and other risk factors. RESULTS: Of 2004 clients with HIV/AIDS who received cervical cancer screening, 378 (18.9%) had a VIA+ result. The odds of being VIA+ were 2.39 times higher among women with a history of sexually transmitted infections (AOR = 2.39; 95% CI: 1.72-3.31). Women who had multiple life time sexual partners had 1.94 times higher odds of being VIA+ (AOR = 1.94; 95% CI: 1.45-2.58). Similarly, women whose spouse with unknown life time number of sexual partners had 1.7 times higher odds of being VIA + as compared with monogamous [AOR = 1.71, 95% CI = 1.09, 2.68].The odds were also higher among women with increased parity (AOR = 2.06; 95% CI: 1.28-3.30) and those who initiated sexual activity before the age of 18 (AOR = 1.57; 95% CI: 1.23-2.01). CONCLUSIONS: This study showed a high magnitude of precancerous cervical lesions, affecting nearly to one- fifth of women living with HIV. Key risk factors identified multiple sexual partners, history of sexually transmitted infections (STIs), parity, and early sexual debut. This study demonstrates the need to support implementation efforts that prioritize and facilitate STIs prevention and safer sexual practices.