Cervical Cancer Screening Outcomes for HIV-positive Women in the Lubombo and Manzini regions of Eswatini – Prevalence and Predictors of a Positive Visual Inspection with Acetic Acid (VIA) Screen

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Abstract This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system. VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n=14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n=7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p=0.096). Screening at mission-owned (OR 1.40; p=0.001), NGO-owned (OR 3.08; p<0.001) and industrial/workplace-owned health facilities (OR 2.37; p=0.044) were associated with positive test results compared to government-owned health facilities, and being within the 35–44 age group (OR 1.26; p=0.017) compared to 25-34 years age group was a positive predictor of a positive VIA screen. Negative predictors of positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (OR 0.76; p=0.004) and ≥10 years (OR 0.66; p=0.002) compared to <5 years; and having an undetectable viral load (OR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.

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