Uptake of cervical cancer screening services among women of reproductive age enrolled in HIV care: a facility-based cross-sectional study in rural Northern Uganda

Abstract

Cervical cancer is a leading cause of morbidity and mortality among women with HIV, who are at higher risk due to immune suppression. Despite the integration of cervical cancer screening into HIV care, uptake remains suboptimal in Uganda. This study assessed the uptake of cervical cancer screening and associated factors among women of reproductive age enrolled in HIV care in Northern Uganda. A facility-based cross-sectional study was conducted among women with HIV (WWHIV) aged 15–49 years attending antiretroviral therapy (ART) clinics at 11 health centres in Northern Uganda. Participants were selected using systematic random sampling from ART clinic registers across 11 health centres (2 Health Centre IVs and 9 Health Centre IIIs) in Lamwo District. Data were collected using a structured questionnaire and analyzed with modified Poisson regression to identify factors independently associated with cervical cancer screening uptake. Of the 389 participants (median age: 34 years (IQR: 29–40)), 51.7% (n = 201) had ever been screened for cervical cancer since enrollment in HIV care. Knowledge of where to access screening strongly predicted uptake (adjusted PR: 8.70, 95% CI: 4.26–17.77, p < 0.001). Women not in marital unions were more likely to be screened than those in unions (adjusted PR: 1.22, 95% CI: 1.03–1.44, p = 0.020). Cervical cancer screening uptake among women in HIV care in Northern Uganda was 51.7%. Awareness of screening locations and marital status significantly influenced uptake. Strengthening the integration of cervical cancer screening into routine HIV care and improving awareness, particularly among married women, may enhance coverage in rural settings.