South African Family Practice

Factors contributing to delayed diagnosis of cervical cancer in human immunodeficiency virus-positive women

Background: Cervical cancer is more prevalent in human immunodeficiency virus (HIV)-positive women and is frequently diagnosed in an advanced stage. This study sought to understand factors contributing to the delayed diagnosis of cervical cancer in HIV-positive women at Mokopane Hospital in the Limpopo Province of South Africa. Methods: A qualitative phenomenological study was conducted using individual interviews among purposively sampled HIV-positive women who were diagnosed with cervical cancer. Interviews were recorded, transcribed verbatim, translated and analysed thematically. Results: Four major themes emerged from the study, providing possible explanations for the delay in cervical cancer diagnosis. Firstly, women believed that Papanicolaou (PAP) smears are diagnostic and should be performed when symptoms appear, rather than for screening. Secondly, their readiness, fear and embarrassment to do the procedure delayed them from having a PAP smear. Thirdly, consulting traditional healers initially, also caused delays. Fourthly, a lack of equipment, inadequate follow-up, health workers’ low index of suspicion and unwillingness to do the procedure further delayed diagnosis. Conclusion: Human immunodeficiency virus-positive women have an inadequate understanding of cervical cancer screening and its importance. Patient education and health worker training are urgently needed to improve the screening. To counteract delays in screening, adequate staffing, regular maintenance and availability of equipment are vital for improved care for HIV-positive women. Contribution: This study highlights how a poor understanding of cervical cancer screening, patients’ readiness, fear and embarrassment to do the procedure, as well as inadequate equipment and poorly motivated health workers, all contribute to the delayed cervical cancer diagnosis in HIV-positive women.

Cervical screening: A complete and patient centred approach

Cervical screening is an important intervention in the detection and management of early cancer. The global situation regarding cervical cancer is briefly discussed and a family physician's approach to the procedure and the response to laboratory findings is documented.

Sociodemographics, behaviour and knowledge of first South African HPV-vaccine recipients

Infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer and is one of the most prevalent sexually transmitted infections worldwide. Primary prevention strategies target reducing HPV acquisition through vaccination, limiting exposure (e.g. delayed sexual debut, barrier contraception) and health education focusing on sexual behaviour and tobacco use. The ImmunoVACCS study, conducted from 2019 to 2022 in two provinces in South Africa, examined sociodemographic characteristics, sexual practices, and knowledge of cervical cancer and the HPV vaccine among young female vaccine recipients. It encompassed participants from the previously conducted vaccine implementation trials, VACCS 1 and VACCS 2 (2011-2014). Recruitment involved telephonic contact with eligible potential participants. Data were collected through self-administered questionnaires. One hundred and eleven participants took part in the current study (median age: 20 years; age range: 16-22 years). Most sexually active participants had their first engagement in secondary school (96.2%), and 77.2% used contraception during their last sexual activity. Knowledge gaps were evident, with only 13.5% recognising cervical cancer's cervix origin and 3.6% attributing it to a virus. Despite this, 70.3% had heard of a vaccine for cervical cancer. Less than half knew about the importance of regular Pap smears (49.5%), vaccine protection (44.1%) or condom use (20.7%) against HPV and cervical cancer. The current study demonstrates that young women still lack complete information on cervical cancer and its risk factors even after receiving health education linked with vaccination.Contribution: This study underscores the necessity of ongoing education about HPV, its risks and preventive measures among young women to combat cervical cancer.

Knowledge and awareness of cervical cancer and human papillomavirus vaccination among female university students

Prevention strategies for reducing cervical cancer incidence rely on informed populations, particularly those most at risk. This study assesses the knowledge and awareness of female university students towards cervical cancer, human papillomavirus (HPV) and its vaccination. A validated self-administered questionnaire was used in a descriptive cross-sectional study among female university students. The data were analysed with Statistical Package for Social Sciences version 26, and p  0.05 was considered significant. The total participants were 190 with a mean age of 22.6 ± 4.35 years. The majority (90%) were aware of cervical cancer, and 78.9% agreed it is a terminal illness, but fewer participants knew it was associated with infection (63.7%), and that it had effective risk-reducing methods (70.5%). Only 32.6% were aware of the Pap smear test, less than half (43.2%) were aware of the cervical cancer vaccine and only 43.7% knew it was available locally. Although fewer (39.5%) considered themselves susceptible to cervical cancer, many (62.1%) would like a Pap smear test. Overall, 88.9% of the participants possessed adequate knowledge of cervical cancer, 67.9% of the HPV vaccine and only 33.7% of HPV. Ethnicity (p = 0.03), year of study (p = 0.001) and institution (p = 0.002) were all significantly associated with knowledge levels, vaccine awareness and Pap smear test awareness. Participants showed low HPV knowledge and varying awareness levels regarding cervical cancer, HPV and HPV vaccine.Contribution: This study provides insights into female university students' knowledge and awareness gaps, highlighting the need for targeted interventions.

Prevalance of abnormal vault cytology after hysterectomy for cervical intraepithelial neoplasia, Pietermaritzburg

A simple hysterectomy is considered the definitive treatment modality for cervical intraepithelial neoplasia (CIN). However, it is associated with recurrence of vaginal intraepithelial neoplasia (VAIN) of up to 7.4%. We sought to determine recurrence rates of VAIN, in women living with HIV (WLWH) and non-infected women. This was a descriptive retrospective review of patients who received a simple hysterectomy for CIN between January 2015 and December 2017 in Pietermaritzburg. Fifty-eight files were reviewed. Forty-two (72.4%) WLWH were seen; amongst those, 76.2% were virally suppressed. Abnormal vault cytology was only seen in patients with CIN grades 2 and 3. The recurrence rates for high-grade squamous intraepithelial lesion (HSIL) were 6.1% and 5.0% at 6 and 12 months, respectively. Human immunodeficiency virus co-infection was associated with 26.2% versus 13.3% of abnormal vault cytology compared to the HIV-negative counterparts (p = 0.164). Virologically suppressed patients had more abnormal cytology (28.1% vs. 0%) compared to the unsuppressed patients. There was a 17.2% and 65.5% loss- to follow-up rates at 6 and 12 months, respectively. Recurrence of premalignant lesions was noted amongst those who had the abdominal approach. The recurrence rates were comparable to the previous literature. A 6-month cytology follow-up showed no added benefit. Human immunodeficiency virus co-infection didn't show a statistical significance on the recurrence rates; however, more structured studies are required to address this. Primary health care-based post operative surveillance can be a solution to address high loss to follow-up.