Description
Background: In Uganda, Cervical cancer (CC) ranks the most common cancer among women Human Papilloma Virus (HPV) serotypes 16 and 18 contribute up to 57.0% of the invasive cervical cancers, with current HIV prevalence of 7.4% among women, Women living with Human Immunodeficiency Virus, HIV (WLHIV) are six time more at risk of developing CC than the negative women. Age standardized incidence and mortality rates of 56.2 and 41.4% per 100,000 respectively hence drift of the World health Organization (WHO) 90-70-90 global strategy to eliminate CC by 2030.
Despite this, HIV and CCS programs in Uganda have remained disintegrated regardless of MOH endorsement as an effective strategy for increasing uptake of CCS, facilitating early detection and treatment among WLHIV. In Uganda, this strategy has not yet been in most HIV clinics though acceptability and accessibility of this intervention is of great relevance WLHIV should be reassured of confidentiality and reduced waiting time to increase uptake of integrated CC screening and HIV services.
Nonetheless, most (80%) Ugandan women have advanced CC disease (stage III or higher) at initial presentation for care, and as little as 5% of women have ever screened for CC, in western Uganda , majority of WLHIV (64.5%) accepted integration of cervical cancer screening into routine HIV care with only 35.5% denying (Ninsiima,2023).However, in Busia District in East and central Uganda there is a dearth of literature on integration of CC using HPV DNA self-sampling technique among WLHIV with the existing HIV care and treatment settings.
Objective: To improve CCS among all eligible newly diagnosed HIV positive women attending Busia HCIV ART clinic from 25% in September 2023 to 100% by end of December 2023.
Methods: In response to the regional rollout of the HPV-NDA based technique for CCS, site level improvement team (WIT) conducted a detailed Route cause analysis and findings over eluded to; client hesitancy and stigma due to myths, out stocks for HPV-DNA kits, suboptimal CQI initiatives, staff knowledge gaps on key HPV-DNA based CCS innovation, inconsistent data management.
Therefore, this informed full brown CCS-HIV clinic integration focused change package through WIT for a period of three months (October to December 2023). Staff capacity building on HPV-DNA concepts, adoption of CCS-HIV clinic integration schematic, robust teamwork Mechanisms-Focal person service tracking, Integration of CCS peer advocacy led comprehensive health education sessions, efficient stock management and robust data management in particular timely data entries into PIRS and EMR data synchronization.
Results: By end of December 2023, Busia HC IV achieved (4/4)100% HPV-DNA based CCS and service integration into the routine baseline tests for all Newly among all eligible WLHIV from (1/4) 25% by end of September 2023,
Conclusion: CCS integration into routine HIV care and management baseline investigations improves service uptake though robust quality improvement initiatives hence recommend scaling up for adoption into similar settings to expedite achievement of global 90-70-90 WHO target by 2030 to avert national CC related deaths among the women for improved health quality through the life course aimed at gross national productivity
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