Integrating Human Papillomavirus and HIV Services Into a One-Stop Breast Cancer Early Detection Clinic in Zambia

Abstract

PURPOSE: Women in low- and middle-income countries face overlapping burdens of breast cancer, cervical cancer, and HIV. Fragmented service delivery contributes to delayed prevention, missed diagnoses, and inefficient use of scarce health resources. We evaluated the feasibility and acceptability of an integrated service delivery model in which HIV and human papillomavirus (HPV) testing were incorporated into an established One-Stop Breast Care Clinic at the primary care level in Zambia. METHODS: Between October 2021 and March 2022, women attending the breast clinic were recruited using convenience sampling. Before breast assessment, participants were offered HIV testing and instructed in HPV self-collection. Samples were processed onsite, in the facility's laboratory, and referrals were guided by test results. Patient satisfaction was assessed through structured questionnaires. Feasibility, acceptability, and implementation challenges were explored through semi-structured interviews with hospital administrators. RESULTS: Among 180 participants (the majority <55 years), 23.3% tested positive for HPV and 18.9% for HIV; all were referred for immediate follow-up care. Breast evaluations identified benign disease in 86.7% and malignancy in 13.3%. Overall satisfaction with receiving integrated HIV and HPV services during breast evaluation was high (97.2%). Satisfaction with clinic flow was reported as satisfactory by 63.9% and highly satisfactory by 33.9% of participants. Hospital administrators highlighted improved efficiency and patient-centeredness of the integrated model. The principal barrier to sustainability was the cost of HPV testing. CONCLUSION: Integration of cervical cancer screening, breast cancer early detection, and HIV services into a single women-centered clinic at the primary care level is feasible, acceptable, and resource-efficient. This model aligns with global elimination and early detection targets and offers a scalable approach to strengthen women's health services in resource-limited settings.