Cervical cancer screen-and-treat services at HIV treatment sites in Nigeria: findings from the ICON-3 Practice Based Research Network

Abstract

Cervical cancer remains a major public health concern in Nigeria, particularly among women living with HIV (WLHIV). While treatable if detected early, many WLHIV do not access cervical cancer screening and treatment services. Accordingly, the Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS) Study aims to test implementation strategies to enhance cervical cancer screening and treatment among WLHIV in 12 Nigeria Implementation Science Alliance Model Innovation and Research Centers (NISA-MIRCs) of the ICON-3 Practice Based Research Network. Prior to the trial commencement, we conducted a baseline cross-sectional study to assess cervical cancer screening, pre-cancer treatment, and referral for suspected cancer treatment at the 12 NISA-MIRCs. Data were obtained from electronic medical records and analyzed with descriptive statistics. Out of 23,409 WLHIV who visited the sites during a six-month period (March to August 2023), 13,518 (57.7%) were eligible for screening, but only 4,499 (33.3%) were screened. The South West had the highest screening rate (65.5%), while the North West had the lowest (22.4%). Of the 112 WLHIV (2.7%) who screened positive with visual inspection with acetic acid (VIA), 73.2% were treated on-site. Twenty-three (0.5%) of those screened had suspected cancer, out of which 15 (65.2%) were referred to an oncology center. The results show significant gaps in cervical cancer prevention services in Nigeria and considerable regional disparities. There is a need for implementation research studies, such as ACCESS, to identify effective strategies for improved cervical cancer screening and treatment among WLHIV in Nigeria.