Barriers and facilitators of integrating cervical cancer screening into routine HIV care and acceptability of self-sampling for HPV DNA testing among people with HIV: An exploratory study in southern Ghana

Evelyn Yayra Bonney¹Emmanuel Frimpong Gyekye¹Jonathan Klutse¹Dzidzor Aku Attoh¹Yeena Abla Tay¹Nicholas Ekow Thomford²Mary Amoakoh-Coleman¹Kwadwo Ansah Koram¹George Boateng Kyei^1,3,4*Collins Stephen Ahorlu^5*

• ¹Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
• ²University of Cape Coast, Cape Coast, Ghana
• ³Medical Scientific research Centre. University of Ghana Medical Centre, Accra, Ghana, University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
• ⁴Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA, Washington University in St Louis School of Medicine, St. Louis, United States
• ⁵Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana

Background: Cervical cancer poses a substantial global health challenge, disproportionately affecting low-and middle-income nations. Women living with HIV are disproportionately affected compared to the general population. Our study explored the acceptance and preferences of participants regarding cervical cancer screening procedures during their HIV clinic visits. Methods: Using the Consolidated Framework for Implementation Research (CFIR) to inform questions, we conducted semi-structured in-depth qualitative interviews with 85 people with HIV (PWH), across six southern Ghana sites, to identify factors that could promote or impede the integration of cervical cancer screening into HIV care in Ghana. We also explored the acceptability of self-sampling versus provider-sampling among respondents. Thematic analysis was performed on the data using the MAXQDA software. Results: Most participants demonstrated a strong willingness to participate in cervical cancer screening, were motivated by because of the desire to know their health status, protect themselves, benefit from early detection and access timely treatment. We identified potential for early detection and treatment, improved health outcomes, increased health awareness, better management of multiple health conditions, and empowerment through health knowledge as facilitators. Participants articulated a multifaceted approach to screening integration, conceptualizing leadership as a collaborative effort involving multiple stakeholders, including healthcare providers, government agencies, non-governmental organizations, HIV program coordinators, and researchers. Our finding suggests that women living with HIV (WLWH) were comfortable with trained nurses administering thermal ablation for cervical cancer, even if they had no prior knowledge of the procedure. Acceptability of cervical cancer screening integration into routine care could be high when barriers were addressed.