Cervical cancer screening utilization and associated factors among women living with HIV in Ethiopia, 2024: systematic review and meta-analysis

Abstract

Abstract Background Cervical cancer is a significant global health challenge, with the majority of cases and deaths occurring in low-resource regions like sub-Saharan Africa including Ethiopia. Women living with HIV (WLHIV) in this area face a six-fold higher risk of cervical cancer compared to women living without HIV Both the availability of screening services and their utilization remain low, particularly among WLHIV, hindering efforts to reduce the cervical cancer burden in this vulnerable population. Objective This study aimed to synthesize the current research on the prevalence of cervical cancer screening utilization and the associated factors among women living with HIV in Ethiopia. Method We conducted a comprehensive systematic review and meta-analysis, searching databases such as Google Scholar, PubMed, and the Cochrane Library for relevant studies published from 2015 up to 2023 and the search period for these relevant articles was from April 1 up to April 30, 2024. Data from included studies was extracted, organized in Excel, and then analyzed using STATA 17. The overall effect across all studies was calculated using a random-effect model. Potential publication bias and heterogeneity in the results between studies were assessed using Egger’s test, forest plot, and I² statistic, respectively. Result According to the systematic review and meta-analysis, the overall prevalence of cervical cancer screening utilization among women living with HIV in Ethiopia was 24% (17 − 32%). Several factors were independently associated with cervical cancer screening utilization, including age (40–49) years (OR = 3.95, 95% CI: 3.307–4.595), age (18–29) years (OR = 5.021, 95% CI: 1.563–9.479), education level greater than college (OR = 3.293, 95% CI: 1.835–4.751), having good knowledge (OR = 3.421, 95% CI: 2.928–3.915), early initiation of sexual intercourse (OR = 3.421, 95% CI: 2.928–3.915), awareness of cervical cancer (OR = 3.551, 95% CI: 2.945–4.157), having information about cancer (OR = 3.671, 95% CI: 2.606–4.736), CD4 count less than 500 cell/mm3 (OR = 4.001, 95% CI: 1.463–6.539), government employee (OR = 5.921, 95% CI: 1.767–10.076), and perceived susceptibility (OR = 2.950, 95% CI: 2.405–3.496). Conclusion This systematic review and meta-analysis show that the pooled prevalence of cervical cancer screening rates among Women living with HIV in Ethiopia is notably low, at only 24%. Factors influencing service utilization include age, education level, knowledge about cervical cancer, early sexual initiation, awareness of the disease itself, and HIV-related conditions. To enhance screening rates, interventions must target these factors and address systemic healthcare deficiencies.

Keywords

• Cervical cancer
• Cervical cancer screening
• Utilization
• HIV
• Ethiopia