1. Dorcas Obori-Yeboah and team
Knowledge and experience of human papillomavirus and cervical cancer screening in a cohort of HIV-positive and HIV-negative Ghanaian women 
Dorcas Obiri- Yeboah
School of Medical Sciences, UCC
11/27/2018
Dorcas Obori-Yeboah and team

2. Dorcas Obori-Yeboah and team
Problem statement
Understanding the screening process and the benefits of early treatment are fundamental to women engaging in follow-up care (Hansen et al. 2011)
Yet, knowledge and experience of women who have had cervical screening is under-researched; esp among HIV positive women with a higher risk
Background
Barriers to women attending screening include embarrassment related to sample collection, fear of pain, and fear of cancer diagnosis
(Marlow et al. 2015)
11/27/2018
Dorcas Obori-Yeboah and team

3. Aim
To examined knowledge and understanding of HPV and cervical cancer and evaluate experiences of screening in a cohort of HIV positive and negative women.

4. Methodological issues
Research design
Mixed method
Method
Survey and FGDs
Target population
Undergoing HPV testing and Pap Screening 6 mths
Sampling technique
Systematic sampling
Sample
131 women: HIV-positive n=55;
2 groups of 8
Study site
CCTH ART Centre and General OPD
Ethical Clearance
 UCC/LSHTM institutional review boards
11/27/2018
Dorcas Obori-Yeboah and team

5. Dorcas Obori-Yeboah and team
Results
11/27/2018
Dorcas Obori-Yeboah and team

6. Knowledge scores- HIV negatives vs. positives
Questions with the highest proportion of correct responses:
HPV being sexually transmitted (86.7%, 100%)
HPV being the cause of cervical cancer (91.9%, 98.2%)
condoms being partially protective (82.7%, 94.6%)
cervical cancer being preventable (90.8%, 94.6%).
11/27/2018
Dorcas Obori-Yeboah and team

7. Questions with the highest proportion of incorrect/unsure responses:
HIV-negative (%*) N=76
HIV-positive (%*) N=55
p value
HPV infection is rare: not many people have it
True
20.0%
25.5%
0.06
False
41.3%
21.8%
Unsure
38.6%
52.7%
Cervical cancer is rare in Ghana
33.3%
0.005
40.0%
23.6%
26.7%
54.6%
There are no stages to cervical cancer; either you have it or you don’t
29.7%
67.3%
<0.001
51.4%
18.9%
7.3%
11/27/2018
Dorcas Obori-Yeboah and team

8. Dorcas Obori-Yeboah and team
HPV acquisition
“The way through which we come to get it [HPV virus] is if we and men about three or four have sex.” (P01, HIV-positive)
Nature of the disease
“Me too I think that if you are there with someone and he has it, you will see that his skin is changing” (P141, HIV-positive).
11/27/2018
Dorcas Obori-Yeboah and team

9. Dorcas Obori-Yeboah and team
Prevention
“Eeeem… some people do not like condom so they will have to, reduce the men they do sex with and all that” (P41, HIV-positive)
“If education could be given on radio and TV, for me, I believe it would help us.” (P157, HIV-negative)
11/27/2018
Dorcas Obori-Yeboah and team

10. Experience of screening: Negatives vs. Positives
30.7% vs. 35.0% agreed that screening was embarrassing
most women did not find screening painful (85.3% vs %).
11/27/2018
Dorcas Obori-Yeboah and team

11. “source of fears/concerns”
“The way the doctor said it on TV made it sound scary.” (P164, HIV-negative)
“I was scared, waiting for the result was very scary. I could not even sleep.” (P316, HIV-negative)
11/27/2018
Dorcas Obori-Yeboah and team

12. Dorcas Obori-Yeboah and team
Around a third found screening embarrassing
Need to explore self-sampling methods (Obiri- Yeboah, Adu- Sarkodie et al )
Recommendations
Significant anxiety around waiting for results
Better counselling and reduce waiting time (McCaffery et al. 2006)
Specific misconceptions highlighted through the FGDs, with stigmatising language used around the acquisition of HPV
Need to explore more tailored educational messages
(Williams et al )(White et al. 2012)
11/27/2018
Dorcas Obori-Yeboah and team

13. Dorcas Obori-Yeboah and team
Conclusion
A standardised education tool explaining cervical screening and specifically HPV-DNA testing in Ghana is needed, which should be accessible to women with low formal education, and should take into account the different needs of HIV-positive women.
11/27/2018
Dorcas Obori-Yeboah and team

14. Dorcas Obori-Yeboah and team
Thank you
11/27/2018
Dorcas Obori-Yeboah and team