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. 2019 Mar 18;19(1):318.
doi: 10.1186/s12889-019-6638-z.

Adherence to screening appointments in a cervical cancer clinic serving HIV-positive women in Botswana

Francis Barchi  1 , Samantha C Winter  2 , Faith Mompati Ketshogile  3 , Doreen Ramogola-Masire  4
Affiliations

Adherence to screening appointments in a cervical cancer clinic serving HIV-positive women in Botswana

Francis Barchi et al. BMC Public Health. .

Abstract

Background: The link between human immunodeficiency virus (HIV) and cervical cancer is of particular concern in Botswana, where one in four women at risk for cervical cancer is HIV-positive. In settings where co-occurrence of these diseases is high, adherence to screening appointments is essential to ensure detection and early treatment.

Methods: This study took place in a cervical cancer-screening program in an HIV clinic in Botswana. Data for this analysis came from 1789 patient records and 257 semi-structured surveys about the screening consent process that were completed by a subset of patients.

Results: Forty percent of women kept their scheduled follow-up appointments. Findings suggest that women treated at first visit or referred for additional treatment due to the presence of more advanced disease had more than double the odds of adhering to follow-up appointments compared to women with negative screens. Women who completed the 35-min surveys in the embedded consent study were found to have 3.7 times greater odds of adhering to follow-up appointment schedules than women who did not. Factors such as age, education, income and marital status that have been shown elsewhere to be important predictors of adherence were not found to be significant predictors in this study.

Conclusions: HIV-positive women in Botswana who are symptom free at initial screening may be lost to essential future screening and follow-up care without greater targeted communication regarding cervical cancer and the importance of regular screening. Strategies to reinforce health messages using cell phone reminders, appointment prompts at time of anti-retroviral drug (ARV) refills, and use of trained community workers to review cervical cancer risks may be effective tools in reducing the burden of cervical cancer disease in HIV-positive women in this setting.

Keywords: Adherence; Botswana; Cancer screening; Cervical cancer; HIV.

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Conflict of interest statement

Ethics approval and consent to participate

The study underwent ethics review by the Health Research and Development Committee of the Botswana Ministry of Health and Wellness and the Ethics Committee at Princess Marina Hospital in Gaborone; in the United States the study was reviewed by Institutional Review Boards at the University of Pennsylvania and Rutgers University. In addition, permission to conduct research at the Bontleng Clinic was received from the Ministry of Local Government in Botswana and the Gaborone City Council, which hasjurisdiction over the Bontleng Clinic and its patients. All patients gave their verbal consent to participate in the screening program and those who agreed to participate in the embedded consent study so indicated with written consent or witnessed verbal consent if they were unable to sign their names.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Derivation of full sample (medical records only) for analysis
Fig. 2
Fig. 2
Derivation of embedded sample for analysis
See this image and copyright information in PMC

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