Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model.

BACKGROUND: Women living with HIV are at increased risk of developing cervical cancer (CC). Screening for cancer is an important preventive strategy for the early detection of precancerous lesions and its management. There has been inadequate evidence on cervical cancer screening (CCS) practices among HIV-positive women in rural western Uganda. This study aimed to assess the prevalence and predictors of CCS among HIV-positive women, as well as knowledge and practices regarding cervical cancer screening. METHODS: A cross-sectional, analytical study was conducted among HIV-positive women attending HIV care facilities located in rural settings of western Uganda. A validated and interview-based data collection form was used to capture statistics regarding demographics, HIV care, obstetric profile, health belief constructs, and knowledge and history of CCS from the participants. Bivariate and multivariate logistic regression analyses were used to correlate women's characteristics and health beliefs toward CCS practices. RESULTS: The prevalence of CCS among HIV-positive women was found to be 39.1% (95%CI: 14.0-71.7). A multivariate logistic regression analysis showed that post-secondary education attainment (AOR = 3.21; 95%CI = 2.12-7.28), four years or more lapsing after being diagnosed as HIV-positive (AOR = 2.87; 95%CI = 1.34-6.13), having more than one child (AOR = 1.87; 95%CI = 1.04-3.35), antenatal care attendance (AOR = 1.74; 95%CI = 1.02-3.43), post-natal care attendance (AOR = 3.75; 95%CI = 1.68-5.89), and having good knowledge regarding CC (AOR = 1.26; 95%CI = 1.98-3.02) were positively associated with adherence to CCS among HIV-positive women in western Uganda. Health Belief Model (HBM) constructs like the perceived risk of developing CC (AOR = 1.82; 95%CI = 1.16-2.01), worries about developing CC (AOR = 5.01; 95%CI = 4.26-8.32), believing that CC leads to death (AOR = 2.56; 95%CI = 1.64-3.56), that screening assists in early identification (AOR = 2.12; 95%CI = 1.84-3.74) and treatment (AOR = 4.63; 95%CI = 2.78-6.43) of precancerous lesions, reducing the risk of mortality (AOR = 1.84; 95%CI = 1.12-2.75), and the reassurance provided by negative test results (AOR = 2.08; 95%CI = 1.33-4.22) were positively associated with adhering to CCS. A female doctor performing the screening (AOR = 2.02; 95%CI = 1.57-3.98) as well as offering a free screening service (AOR = 3.23; 95%CI = 1.99-4.38) were significantly associated with CCS. Meanwhile, screening being painful (AOR = 0.28; 95%CI = 0.12-0.45), expensive (AOR = 0.36; 95%CI = 0.24-0.53), time-consuming (AOR = 0.30; 95%CI = 0.19-0.41), embarrassing (AOR = 0.02; 95%CI = 0.01-0.06), and the fear of positive results (AOR = 0.04; 95%CI = 0.02-0.10) were found to have a significant negative association with adhering to CCS. CONCLUSIONS: Only one-third of HIV-positive women had undergone CCS. Variables including secondary education attainment, four years or more lapsing after being diagnosed as HIV-positive, having more than one child, antenatal care attendance, post-natal care attendance, and knowledge about CC were positively associated with CCS adherence. Educational programs should be geared towards the risk of CC, severity of cases, benefits of screening, and reducing barriers associated with screening, which can significantly improve cervical CCS among HIV-positive women. The study proposes the incorporation of free screening services and the inclusion of trained female staff in CC prevention policies to improve CCS.

Adverse events following COVID-19 vaccination among pregnant women attending primary health centers: An active-surveillance study.

Introduction: Vaccine safety is a major barrier to the uptake of the COVID-19 vaccine by pregnant women. To bring confidence among pregnant women towards vaccine intake, there is a need to synthesize evidence on safety profile of vaccination. Objective: To assess adverse events (AEs) following COVID-19 vaccination among pregnant women. Materials and methods: A vaccine safety surveillance was conducted at 2 rural primary health centers (PHC) located in Anantapur District, India. A total of 420 pregnant women were monitored for AEs following COVID-19 vaccination for a period of 30 min and followed for 1 month for late reactions through telephonic interviews. All AEs were subjected to causality and severity assessment. Descriptive statistics were used to represent adverse events. Results: The COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A total of 420 pregnant women received 670 vaccine doses (Covishield = 372, Covaxin = 298) against COVID-19. Majority of vaccine intake was observed during the second trimester. The incidence rate of AEs following the COVID-19 vaccine among pregnant women was 93.8%, and the majority include injection site pain (28.4%, 29.6%), fever (25.5%, 19.0%), myalgia (8.21%, 12.3%), and malaise (13.6%, 8.4%). Most AEs notified are probable and mild in nature. Conclusion: The COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A 30 days incidence rate of AEs following COVID-19 vaccination among pregnant women was 93.8%, with the most common mild events like injection site pain, and fever. A further follow-up cohort study by taking an adequate sample size was recommended to capture fetal-maternal outcomes.

Introducción: La seguridad de la vacuna es una barrera importante para la adopción de la vacuna COVID-19 por parte de las mujeres embarazadas. Para llevar confianza entre las mujeres embarazadas hacia la ingesta de vacunas, es necesario sintetizar la evidencia sobre el perfil de seguridad de la vacunación. Objetivo: Evaluar los eventos adversos (EA) después de la vacunación contra la COVID-19 en mujeres embarazadas. Materiales y métodos: Se llevó a cabo una vigilancia de la seguridad de las vacunas en dos centros rurales de atención primaria de salud (PHC) ubicados en el distrito de Anantapur, India. Un total de 420 mujeres embarazadas fueron monitoreadas para detectar EA después de la vacunación COVID-19 durante un período de 30 minutos y seguidas durante un mes para detectar reacciones tardías a través de entrevistas telefónicas. Todos los EA se sometieron a una evaluación de causalidad y gravedad. Se utilizaron estadísticas descriptivas para representar los eventos adversos. Resultados: La tasa de aceptación de la vacuna COVID-19 entre las mujeres embarazadas fue del 64,4%. Un total de 420 mujeres embarazadas recibieron 670 dosis de vacunas (Covishield = 372, Covaxin = 298) contra COVID-19. La mayoría de la ingesta de vacunas se observó durante el segundo trimestre. La tasa de incidencia de EA después de la vacuna COVID-19 entre las mujeres embarazadas fue del 93,8%, y la mayoría incluye dolor en el lugar de la inyección (28,4%, 29,6%), fiebre (25,5%, 19,0%), mialgia (8,21%, 12,3%) y malestar general (13,6%, 8,4%). La mayoría de los EA notificados son de naturaleza probable y leve. Conclusión: La tasa de aceptación de la vacuna COVID-19 entre las mujeres embarazadas fue del 64,4%. Una tasa de incidencia de EA a 30 días después de la vacunación contra COVID-19 entre las mujeres embarazadas fue del 93,8%, con los eventos leves más comunes como dolor en el lugar de la inyección y fiebre. Se recomendó un estudio de cohorte de seguimiento adicional mediante la toma de un tamaño de muestra adecuado para capturar los resultados maternos fetales.